Provider Demographics
NPI:1467027649
Name:MAUER, JAKOB (LICSW, LCSW)
Entity Type:Individual
Prefix:
First Name:JAKOB
Middle Name:
Last Name:MAUER
Suffix:
Gender:M
Credentials:LICSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10650 DEAN MARTIN DR UNIT 412
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89141-3589
Mailing Address - Country:US
Mailing Address - Phone:406-396-5168
Mailing Address - Fax:
Practice Address - Street 1:1070 W HORIZON RIDGE PKWY STE 210
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89012-6020
Practice Address - Country:US
Practice Address - Phone:702-405-0904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-20
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9244-S1041C0700X
MN290661041C0700X
NV10450-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNLMN729698116Medicaid