Provider Demographics
NPI:1245793843
Name:MAYES, DEBORAH DENISE (AMFT)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:DENISE
Last Name:MAYES
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 N MARKET ST UNIT 4
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90302-5041
Mailing Address - Country:US
Mailing Address - Phone:323-422-7490
Mailing Address - Fax:
Practice Address - Street 1:5600 RICKENBACKER RD BLDG 2AB
Practice Address - Street 2:
Practice Address - City:BELL
Practice Address - State:CA
Practice Address - Zip Code:90201-6694
Practice Address - Country:US
Practice Address - Phone:323-263-1206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-10
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAII055530518101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty