Provider Demographics
NPI:1790162188
Name:MAYER, JANIS (CADC)
Entity Type:Individual
Prefix:
First Name:JANIS
Middle Name:
Last Name:MAYER
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4912 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73109-3838
Mailing Address - Country:US
Mailing Address - Phone:405-604-3784
Mailing Address - Fax:405-605-7820
Practice Address - Street 1:4912 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73109-3838
Practice Address - Country:US
Practice Address - Phone:405-604-3784
Practice Address - Fax:405-605-7820
Is Sole Proprietor?:No
Enumeration Date:2015-05-05
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK315101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)