Provider Demographics
NPI:1124749528
Name:MAYS, ROCKAEL
Entity type:Individual
Prefix:
First Name:ROCKAEL
Middle Name:
Last Name:MAYS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 MERRIAM PKWY
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-7087
Mailing Address - Country:US
Mailing Address - Phone:618-494-3064
Mailing Address - Fax:
Practice Address - Street 1:4972 BENCHMARK CENTRE DR STE 100
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:IL
Practice Address - Zip Code:62226-2070
Practice Address - Country:US
Practice Address - Phone:618-494-3064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-06
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180016619101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health