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NPI Code Detail

MEDICARE: ADAM JAMES MAYNARD

MEDICARE: ADAM JAMES MAYNARD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health CounselorAPCC21402CA
2171M00000XCase Manager/Care Coordinator
3172V00000XCommunity Health Worker
4390200000XStudent in an Organized Health Care Education/Training Program
5106S00000XBehavior Technician

General Provider Information

NPI Number : 1518638675
Entity Type Code : Individual
Provider Name (Legal Business Name) : ADAM JAMES MAYNARD
Provider Business Mailing Address
First Line : 2423 W MARCH LN STE 200
Second Line :
City : STOCKTON
State : CA
Zip : 95207-8250
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2423 W MARCH LN STE 200
Second Line :
City : STOCKTON
State : CA
Zip : 95207-8250
Country : US
Telephone Number : 209-478-9862
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/27/2021
Last Update Date : 12/30/2025

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