1417210865 NPI number — DEVYN DEONA MAYER LPC

Table of content: DR. JULIO SANTORY -ORTIZ (NPI 1013979723)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417210865 NPI number — DEVYN DEONA MAYER LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAYER
Provider First Name:
DEVYN
Provider Middle Name:
DEONA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MERRELL
Provider Other First Name:
DEVYN
Provider Other Middle Name:
DEONA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1417210865
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/01/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3520 RANCH HOUSE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILLOW PARK
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76087-7659
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-709-3243
Provider Business Mailing Address Fax Number:
817-441-6129

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
104 W RUSSELL ST
Provider Second Line Business Practice Location Address:
PYRAMID COUNSELING CENTER
Provider Business Practice Location Address City Name:
WEATHERFORD
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76086-5360
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-594-8780
Provider Business Practice Location Address Fax Number:
817-862-7478
Provider Enumeration Date:
06/20/2012

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:  14822 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 38692 . This is a "AETNA BETTER HEALTH" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 398481 . This is a "AVAILITY" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 300568801 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 712LLC . This is a "BLUE CROSS BLUE SHIELD OF TEXAS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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