Provider Demographics
NPI:1073153698
Name:MAUS, ZANE ALAN
Entity Type:Individual
Prefix:
First Name:ZANE
Middle Name:ALAN
Last Name:MAUS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 SUNSET VILLA CIR
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366-2281
Mailing Address - Country:US
Mailing Address - Phone:618-979-0655
Mailing Address - Fax:
Practice Address - Street 1:311 S MAIN ST STE 100
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63366-2807
Practice Address - Country:US
Practice Address - Phone:636-281-1990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-11
Last Update Date:2020-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017038616101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor