Provider Demographics
NPI:1093317901
Name:MAULSON, KEVIN DEAN
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:DEAN
Last Name:MAULSON
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 1:135 E RAY RD STE 7
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-3376
Mailing Address - Country:US
Mailing Address - Phone:480-433-0037
Mailing Address - Fax:
Practice Address - Street 1:135 E RAY RD STE 7
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-3376
Practice Address - Country:US
Practice Address - Phone:480-433-0037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility