MEDICARE: RAQUEL MAYER MA, NCC

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1538617444
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAQUEL MAYER MA, NCC

Provider Business Mailing Address
First Line	:	PO BOX 16756
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97292-0576
Country	:	US
Telephone Number	:
Fax Number	:	503-208-2596

Provider Business Practice Location Address
First Line	:	7916 SE FOSTER RD STE 201
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97206-4289
Country	:	US
Telephone Number	:	818-645-8930
Fax Number	:	503-208-2596

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

Provider Enumeration Date	:	09/20/2016
Last Update Date	:	02/13/2018

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