Provider Demographics
NPI:1508251588
Name:DUSTIN MAYS, LMSW, PLLC
Entity Type:Organization
Organization Name:DUSTIN MAYS, LMSW, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWER
Authorized Official - Prefix:
Authorized Official - First Name:DUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYS
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:208-284-6243
Mailing Address - Street 1:684 N 9TH ST
Mailing Address - Street 2:B
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-5458
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:684 N 9TH ST
Practice Address - Street 2:B
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-5458
Practice Address - Country:US
Practice Address - Phone:208-284-6243
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-06
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW- 34638104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty