MEDICARE: MICHAEL H MAYES

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	101Y00000X	Counselor
2	104100000X	Social Worker

General Provider Information

NPI Number	:	1811157712
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL H MAYES

Provider Business Mailing Address
First Line	:	PO BOX 1401
Second Line	:
City	:	CORVALLIS
State	:	OR
Zip	:	97339-1401
Country	:	US
Telephone Number	:	503-480-5086
Fax Number	:

Provider Business Practice Location Address
First Line	:	4719 SW ROSEBERRY ST
Second Line	:
City	:	CORVALLIS
State	:	OR
Zip	:	97333-1793
Country	:	US
Telephone Number	:	503-480-5086
Fax Number	:

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

Provider Enumeration Date	:	06/13/2008
Last Update Date	:	02/01/2014

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Directions to “ MICHAEL H MAYES ” Practice Location

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