Provider Demographics
NPI:1811337728
Name:MAYES, CONNIE J (LMSW)
Entity type:Individual
Prefix:MS
First Name:CONNIE
Middle Name:J
Last Name:MAYES
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 N ROCK RD
Mailing Address - Street 2:SUITE 170
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-2203
Mailing Address - Country:US
Mailing Address - Phone:316-253-1630
Mailing Address - Fax:316-719-3877
Practice Address - Street 1:250 N ROCK RD
Practice Address - Street 2:SUITE 170
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-2203
Practice Address - Country:US
Practice Address - Phone:316-253-1630
Practice Address - Fax:316-719-3877
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-25
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLMSW 3855104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker