MEDICARE: RICHARD MAES

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	101YP2500X	Professional Counselor	6451023006	MI

General Provider Information

NPI Number	:	1083306690
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD MAES

Provider Business Mailing Address
First Line	:	2536 SPRING ARBOR RD
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49203-3602
Country	:	US
Telephone Number	:	517-998-0999
Fax Number	:	517-998-0998

Provider Business Practice Location Address
First Line	:	2536 SPRING ARBOR RD
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49203-3602
Country	:	US
Telephone Number	:	517-998-0999
Fax Number	:	517-998-0998

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

Provider Enumeration Date	:	05/23/2023
Last Update Date	:	05/23/2023

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Directions to “ RICHARD MAES ” Practice Location

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