Provider Demographics
NPI:1699181198
Name:MAYER, NANCY E (LPC)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:E
Last Name:MAYER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:
Other - Last Name:GRUBB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1507 BELMONT DR
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-3222
Mailing Address - Country:US
Mailing Address - Phone:903-283-8729
Mailing Address - Fax:888-454-9083
Practice Address - Street 1:3800 PALUXY DRIVE
Practice Address - Street 2:STE 240
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-1667
Practice Address - Country:US
Practice Address - Phone:903-283-8729
Practice Address - Fax:888-454-9083
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-03
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61238101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX61238OtherSTATE LICENSE