Provider Demographics
NPI:1194819540
Name:MAYWALD, RICHARD A
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:A
Last Name:MAYWALD
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 1:425 E MAIN SUITE 600
Mailing Address - Street 2:
Mailing Address - City:OTHELLO
Mailing Address - State:WA
Mailing Address - Zip Code:99344
Mailing Address - Country:US
Mailing Address - Phone:509-488-5611
Mailing Address - Fax:509-488-0166
Practice Address - Street 1:425 E MAIN SUITE 600
Practice Address - Street 2:
Practice Address - City:OTHELLO
Practice Address - State:WA
Practice Address - Zip Code:99344
Practice Address - Country:US
Practice Address - Phone:509-488-5611
Practice Address - Fax:509-488-0166
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health