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General NPI Number Information
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NPI Number | 1659980043
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Entity Type | Individual
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Provider Name | ILYAS MAYE
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Gender | Male
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Dates
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Enumeration Date | 07/30/2020
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Last Update Date | 02/18/2025
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Provider Practice Location Address
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Address Line | 410 W LAKE ST APT 331
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City | MINNEAPOLIS
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State | MN
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Zip | 55408-6101
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Country | US
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Telephone | 612-407-4245
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Fax |
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Provider Business Mailing Address
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Address Line | 410 W LAKE ST APT 331
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City | MINNEAPOLIS
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State | MN
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Zip | 55408-6101
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Country | US
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Telephone | 612-407-4245
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TA0700X
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Taxonomy Name | Adult Development & Aging Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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