Provider Demographics
NPI:1386855229
Name:MAYNARD, CONNIE S
Entity Type:Individual
Prefix:MS
First Name:CONNIE
Middle Name:S
Last Name:MAYNARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2049 S GIDDINGS ST
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-6338
Mailing Address - Country:US
Mailing Address - Phone:559-734-5270
Mailing Address - Fax:
Practice Address - Street 1:1300 S CROWE ST
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-2106
Practice Address - Country:US
Practice Address - Phone:559-734-5480
Practice Address - Fax:559-734-5783
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)