Provider Demographics
NPI:1588942916
Name:MAHER, PATRICK J
Entity type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:J
Last Name:MAHER
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:PATRICK
Other - Middle Name:J
Other - Last Name:MAHER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS LPC
Mailing Address - Street 1:518 6TH ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-5012
Mailing Address - Country:US
Mailing Address - Phone:605-399-2536
Mailing Address - Fax:
Practice Address - Street 1:518 SIXTH STREET
Practice Address - Street 2:SUITE 6
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701
Practice Address - Country:US
Practice Address - Phone:605-399-2536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-03
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD750101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional