Provider Demographics
NPI:1114267473
Name:MAILEY, CHAZ D (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CHAZ
Middle Name:D
Last Name:MAILEY
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 POYNTZ AVE STE 243
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-0126
Mailing Address - Country:US
Mailing Address - Phone:785-537-6051
Mailing Address - Fax:844-222-3691
Practice Address - Street 1:555 POYNTZ AVE STE 243
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-0126
Practice Address - Country:US
Practice Address - Phone:785-537-6051
Practice Address - Fax:844-222-3691
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-25
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2069103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical