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General NPI Number Information
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NPI Number | 1902292188
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Entity Type | Individual
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Provider Name | DELORES ANN MAYEN LCSW, LMSW-C
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Gender | Female
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Dates
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Enumeration Date | 04/14/2015
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Last Update Date | 08/06/2024
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Provider Practice Location Address
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Address Line | 2021 GUADALUPE ST STE 260
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City | AUSTIN
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State | TX
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Zip | 78705-5654
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Country | US
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Telephone | 646-453-6777
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Fax | 212-337-9841
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Provider Business Mailing Address
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Address Line | 4703 OSAGE CT
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City | ARLINGTON
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State | TX
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Zip | 76018-1066
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Country | US
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Telephone | 989-817-6968
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 112791
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801117536
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 6801106198
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License Number State | MI
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