Provider Demographics
NPI:1639642523
Name:MAHER, CHRISTY (PSYD, LPC)
Entity Type:Individual
Prefix:DR
First Name:CHRISTY
Middle Name:
Last Name:MAHER
Suffix:
Gender:F
Credentials:PSYD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 S FISH HAVEN RD
Mailing Address - Street 2:
Mailing Address - City:LAKE OZARK
Mailing Address - State:MO
Mailing Address - Zip Code:65049-3103
Mailing Address - Country:US
Mailing Address - Phone:661-805-3221
Mailing Address - Fax:
Practice Address - Street 1:1060 OSAGE BEACH RD STE A
Practice Address - Street 2:
Practice Address - City:OSAGE BEACH
Practice Address - State:MO
Practice Address - Zip Code:65065-2266
Practice Address - Country:US
Practice Address - Phone:661-805-3221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-03
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011036052101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional