Provider Demographics
NPI:1083082366
Name:MAYNE, RICHARD (MA, MHCA)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:MAYNE
Suffix:
Gender:M
Credentials:MA, MHCA
Other - Prefix:
Other - First Name:GARY
Other - Middle Name:
Other - Last Name:MAYNE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, MHCA
Mailing Address - Street 1:815 S 9TH ST APT 303
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4571
Mailing Address - Country:US
Mailing Address - Phone:970-590-1198
Mailing Address - Fax:
Practice Address - Street 1:815 S 9TH ST APT 303
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4571
Practice Address - Country:US
Practice Address - Phone:970-590-1198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-03
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool