Provider Demographics
NPI:1447300728
Name:KARDASZ CUNNINGHAM, MARY A (PHD LPC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:A
Last Name:KARDASZ CUNNINGHAM
Suffix:
Gender:F
Credentials:PHD LPC
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:A
Other - Last Name:KARDASZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD, LPC
Mailing Address - Street 1:12 WINDERMERE CT
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-4527
Mailing Address - Country:US
Mailing Address - Phone:636-949-5553
Mailing Address - Fax:
Practice Address - Street 1:820 S MAIN ST
Practice Address - Street 2:SUITE 307
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-3306
Practice Address - Country:US
Practice Address - Phone:636-947-2325
Practice Address - Fax:636-947-5941
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOCS000138101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health