Provider Demographics
NPI:1275869265
Name:MAYGER, NICOLINE BRAENDLE (LPC, NCC)
Entity Type:Individual
Prefix:
First Name:NICOLINE
Middle Name:BRAENDLE
Last Name:MAYGER
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5241 E CAMINO BOSQUE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-4617
Mailing Address - Country:US
Mailing Address - Phone:520-299-3532
Mailing Address - Fax:
Practice Address - Street 1:5241 E CAMINO BOSQUE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-4617
Practice Address - Country:US
Practice Address - Phone:520-299-3532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-26
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-12212101YP2500X
MT1163-LCPC101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional