Healthcare Provider Details

I. General information

NPI: 1184998171
Provider Name (Legal Business Name): BARBARA ANN MAYWARD LPC, CCS, CAADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2012
Last Update Date: 03/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1956 BOSTON ST SE
GRAND RAPIDS MI
49506
US

IV. Provider business mailing address

1956 BOSTON ST SE
GRAND RAPIDS MI
49506-4169
US

V. Phone/Fax

Practice location:
  • Phone: 616-776-0891
  • Fax: 616-243-9854
Mailing address:
  • Phone: 616-776-0891
  • Fax: 616-243-9854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401010152
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: