Basic Information
| Provider Information | |||||||||
| NPI: | 1093169880 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MAYER | ||||||||
| FirstName: | MIKEL | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.S., L.S.W. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 107 PLAZA DR | ||||||||
| Address2: | |||||||||
| City: | SAINT CLAIRSVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 439508786 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7405260204 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 107 PLAZA DR | ||||||||
| Address2: | |||||||||
| City: | SAINT CLAIRSVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 439508786 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7405260204 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2016 | ||||||||
| LastUpdateDate: | 04/18/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | S-0014045 | OH | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.