1184998171 NPI number — BARBARA ANN MAYWARD LPC, CCS, CAADC

Table of content: BARBARA ANN MAYWARD LPC, CCS, CAADC (NPI 1184998171)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184998171 NPI number — BARBARA ANN MAYWARD LPC, CCS, CAADC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAYWARD
Provider First Name:
BARBARA
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPC, CCS, CAADC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184998171
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/08/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1956 BOSTON ST SE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRAND RAPIDS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49506-4169
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
616-776-0891
Provider Business Mailing Address Fax Number:
616-243-9854

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1956 BOSTON ST SE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRAND RAPIDS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49506
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
616-776-0891
Provider Business Practice Location Address Fax Number:
616-243-9854
Provider Enumeration Date:
03/08/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  6401010152 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 6401010152 . This is a "MICHIGAN LICENSE LPC" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: S20108 . This is a "MICHIGAN CERTIFICATION BOARD FOR ADDICTION PROFESSIONALS CCS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: C00736 . This is a "MICHIGAN CERTIFICATION BOARD FOR ADDICTION PROFESSIONALS CAADC" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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