Provider Demographics
NPI:1861185431
Name:INGRASSIA-PAYAN ROSALES, MARY A (PLPC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:A
Last Name:INGRASSIA-PAYAN ROSALES
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:A
Other - Last Name:INGRASSIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2885 W BATTLEFIELD ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-3952
Mailing Address - Country:US
Mailing Address - Phone:417-761-5214
Mailing Address - Fax:417-761-5065
Practice Address - Street 1:1300 E BRADFORD PKWY BLDG A
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-4264
Practice Address - Country:US
Practice Address - Phone:417-761-5000
Practice Address - Fax:417-761-5011
Is Sole Proprietor?:No
Enumeration Date:2023-05-31
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023042293101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional