Provider Demographics
NPI:1730488446
Name:SPRADLING, MARY CORINNE (TLLP)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:CORINNE
Last Name:SPRADLING
Suffix:
Gender:F
Credentials:TLLP
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:CORINNE
Other - Last Name:SPRADLING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:TLLP
Mailing Address - Street 1:122 W SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-4711
Mailing Address - Country:US
Mailing Address - Phone:269-349-4219
Mailing Address - Fax:
Practice Address - Street 1:122 W SOUTH ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-4711
Practice Address - Country:US
Practice Address - Phone:269-349-4219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-21
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL1929389103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling