Provider Demographics
NPI:1902292188
Name:MAYEN, DELORES ANN (LCSW, LMSW-C)
Entity type:Individual
Prefix:MS
First Name:DELORES
Middle Name:ANN
Last Name:MAYEN
Suffix:
Gender:F
Credentials:LCSW, LMSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4703 OSAGE CT
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76018-1066
Mailing Address - Country:US
Mailing Address - Phone:989-817-6968
Mailing Address - Fax:
Practice Address - Street 1:2021 GUADALUPE ST STE 260
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-5654
Practice Address - Country:US
Practice Address - Phone:646-453-6777
Practice Address - Fax:212-337-9841
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-14
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1127911041C0700X
MI68011175361041C0700X
171M00000X
MI6801106198101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health