Provider Demographics
NPI:1215400890
Name:MIALOR, PAYE SR (MHS)
Entity Type:Individual
Prefix:MR
First Name:PAYE
Middle Name:
Last Name:MIALOR
Suffix:SR
Gender:M
Credentials:MHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4104 LAKESIDE AVE N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55429-3803
Mailing Address - Country:US
Mailing Address - Phone:215-341-5619
Mailing Address - Fax:
Practice Address - Street 1:4104 LAKESIDE AVE N
Practice Address - Street 2:
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55429-3803
Practice Address - Country:US
Practice Address - Phone:215-341-5619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-07
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health