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General NPI Number Information
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NPI Number | 1972295376
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Entity Type | Individual
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Provider Name | PAUL MAVERICK MCKAY PH.D
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Gender | Male
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Dates
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Enumeration Date | 05/23/2023
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Last Update Date | 09/03/2024
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Provider Practice Location Address
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Address Line | 155 E SILVER SPRING DR
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City | MILWAUKEE
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State | WI
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Zip | 53217-4704
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Country | US
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Telephone | 414-324-7801
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Fax |
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Provider Business Mailing Address
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Address Line | 5160 N LYDELL AVE
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City | MILWAUKEE
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State | WI
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Zip | 53217-5532
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Country | US
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Telephone |
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 103TH0004X
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Taxonomy Name | Health Psychologist
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License Number |
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 261QC1800X
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Taxonomy Name | Corporate Health Clinic/Center
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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 | 374K00000X
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Taxonomy Name | Religious Nonmedical Practitioner
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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License Number State |
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