Provider Demographics
NPI:1629617287
Name:MAYES, RUSTIE (LLMSW)
Entity Type:Individual
Prefix:
First Name:RUSTIE
Middle Name:
Last Name:MAYES
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:RUSTIE
Other - Middle Name:
Other - Last Name:STEBBINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LLMSW
Mailing Address - Street 1:P.O. BOX 278
Mailing Address - Street 2:
Mailing Address - City:PORT AUSTIN
Mailing Address - State:MI
Mailing Address - Zip Code:48467
Mailing Address - Country:US
Mailing Address - Phone:989-372-5996
Mailing Address - Fax:989-872-1801
Practice Address - Street 1:1332 PROSPECT AVE.
Practice Address - Street 2:
Practice Address - City:CARO
Practice Address - State:MI
Practice Address - Zip Code:48723
Practice Address - Country:US
Practice Address - Phone:989-673-6191
Practice Address - Fax:989-872-1801
Is Sole Proprietor?:No
Enumeration Date:2019-12-31
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical