Provider Demographics
NPI:1609657337
Name:AULD, MAYA ARABELLA
Entity Type:Individual
Prefix:
First Name:MAYA
Middle Name:ARABELLA
Last Name:AULD
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 1:9959 N VAN HOUTEN AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97203-1957
Mailing Address - Country:US
Mailing Address - Phone:503-998-0796
Mailing Address - Fax:
Practice Address - Street 1:9959 N VAN HOUTEN AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97203-1957
Practice Address - Country:US
Practice Address - Phone:503-998-0796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical