MEDICARE: NANCY MAYES

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
1	101Y00000X	Counselor	37AC00659000	NJ

General Provider Information

NPI Number	:	1629797030
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY MAYES

Provider Business Mailing Address
First Line	:	110 COUNTY ROAD 2140
Second Line	:
City	:	EDGAR SPRINGS
State	:	MO
Zip	:	65462-8152
Country	:	US
Telephone Number	:	719-491-6595
Fax Number	:

Provider Business Practice Location Address
First Line	:	110 COUNTY ROAD 2140
Second Line	:
City	:	EDGAR SPRINGS
State	:	MO
Zip	:	65462-8152
Country	:	US
Telephone Number	:	719-491-6595
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2022
Last Update Date	:	08/26/2022

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