Provider Demographics
NPI:1639945827
Name:MAYES, NATHAN RANDALL
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:RANDALL
Last Name:MAYES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20126 BALLINGER WAY NE STE 350
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98155-1117
Mailing Address - Country:US
Mailing Address - Phone:505-410-7243
Mailing Address - Fax:
Practice Address - Street 1:740 NE 56TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-2727
Practice Address - Country:US
Practice Address - Phone:505-410-7243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-28
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC61484395101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health