Active NPI
Mary Elizabeth Bode, MS
- Professional Counselor
- San Angelo, TX
National Provider Identifier
1619020252
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 10165
- Practice address
- 412 Preusser St
San Angelo, TX 76903-3618 - Phone
- (325) 234-2582
- NPI assigned
- Jan 18, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 10165 | TX | Primary |
Addresses
Primary practice location
412 Preusser St
San Angelo, TX 76903-3618
Mailing address
12441 Twin Lakes LN
San Angelo, TX 76904-3973
Phone (325) 224-3181
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10165 | TX | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169078400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1200960000000",
"number": "1619020252",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12441 TWIN LAKES LN",
"city": "SAN ANGELO",
"state": "TX",
"postal_code": "769043973",
"telephone_number": "325-224-3181"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "412 PREUSSER ST",
"city": "SAN ANGELO",
"state": "TX",
"postal_code": "769033618",
"telephone_number": "325-234-2582"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BODE",
"first_name": "MARY",
"middle_name": "ELIZABETH",
"name_prefix": "Ms.",
"credential": "MS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-01-18",
"last_updated": "2008-01-22",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "TX",
"license": "10165",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Angelo, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.