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NPI Code Detail

MEDICARE: MS. WENDY MAYBURY

MEDICARE: MS. WENDY MAYBURY
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1235494675
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. WENDY MAYBURY
Provider Business Mailing Address
First Line : 6605 SE LAKE RD
Second Line :
City : MILWAUKIE
State : OR
Zip : 97222-2161
Country : US
Telephone Number : 503-655-8401
Fax Number :
Provider Business Practice Location Address
First Line : 6605 SE LAKE RD
Second Line :
City : MILWAUKIE
State : OR
Zip : 97222-2161
Country : US
Telephone Number : 503-655-8401
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/11/2012
Last Update Date : 03/21/2024

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