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NPI Code Detail

MEDICARE: STEPHEN MAYVILLE A PROFESSIONAL CORPORATION

MEDICARE: STEPHEN MAYVILLE A PROFESSIONAL CORPORATION
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
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number : 1588289102
Entity Type Code : Organization
Provider Name (Legal Business Name) : STEPHEN MAYVILLE A PROFESSIONAL CORPORATION
Provider Business Mailing Address
First Line : PO BOX 70711
Second Line :
City : RENO
State : NV
Zip : 89570-0711
Country : US
Telephone Number : 775-560-2196
Fax Number : 775-826-6271
Provider Business Practice Location Address
First Line : 10631 PROFESSIONAL CIR STE A
Second Line :
City : RENO
State : NV
Zip : 89521-5835
Country : US
Telephone Number : 775-826-6218
Fax Number : 775-826-6271
Authorized Official
Title or Position : OWNER
Name : DR. STEPHEN MAYVILLE
Credential : PH.D.
Telephone Number : 775-560-2196
Provider Enumeration Date : 06/09/2020
Last Update Date : 07/27/2020

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