MEDICARE: JULIE A MAYER LICDC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	LICDC.16244	OH

General Provider Information

NPI Number	:	1932769197
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE A MAYER LICDC

Provider Business Mailing Address
First Line	:	400 EAST STREET
Second Line	:
City	:	ATHENS
State	:	OH
Zip	:	45769
Country	:	US
Telephone Number	:	740-326-6110
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 E STATE ST
Second Line	:
City	:	ATHENS
State	:	OH
Zip	:	45701-1856
Country	:	US
Telephone Number	:	740-362-6110
Fax Number	:

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

Provider Enumeration Date	:	06/19/2019
Last Update Date	:	01/08/2025

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