Provider Demographics
NPI:1467692954
Name:MAYHALL, MARCUS C (BS)
Entity Type:Individual
Prefix:MR
First Name:MARCUS
Middle Name:C
Last Name:MAYHALL
Suffix:
Gender:M
Credentials:BS
Other - Prefix:MR
Other - First Name:MARCUS
Other - Middle Name:C
Other - Last Name:MAYHALL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BS
Mailing Address - Street 1:6283 CHESTERFIELD LN
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89523-1726
Mailing Address - Country:US
Mailing Address - Phone:775-247-3994
Mailing Address - Fax:
Practice Address - Street 1:741 RANCHO VIA DR
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89434-4051
Practice Address - Country:US
Practice Address - Phone:775-247-3994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-24
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness