Provider Demographics
NPI:1699438192
Name:MAYES, MARIE (MTFA)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:MAYES
Suffix:
Gender:F
Credentials:MTFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7101 SCHNEBLE CIR APT 2
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40214-3856
Mailing Address - Country:US
Mailing Address - Phone:502-712-9723
Mailing Address - Fax:
Practice Address - Street 1:1467 S 9TH ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40208-2254
Practice Address - Country:US
Practice Address - Phone:502-496-4545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-21
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY262546101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health