Provider Demographics
NPI:1164517223
Name:MAESK, DOUG (LMHC)
Entity Type:Individual
Prefix:
First Name:DOUG
Middle Name:
Last Name:MAESK
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 ROYAL PARK DR
Mailing Address - Street 2:4F
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33309-6551
Mailing Address - Country:US
Mailing Address - Phone:954-676-5695
Mailing Address - Fax:954-676-5695
Practice Address - Street 1:102 ROYAL PARK DR
Practice Address - Street 2:4F
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33309-6551
Practice Address - Country:US
Practice Address - Phone:954-676-5695
Practice Address - Fax:954-676-5695
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2009-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH8760101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health