Provider Demographics
NPI:1801197975
Name:MAHAFFEY, JAMES M R (EDD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:M R
Last Name:MAHAFFEY
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 DAYTONA DR
Mailing Address - Street 2:
Mailing Address - City:ROCK SPRINGS
Mailing Address - State:WY
Mailing Address - Zip Code:82901-6867
Mailing Address - Country:US
Mailing Address - Phone:307-212-6644
Mailing Address - Fax:
Practice Address - Street 1:2001 DEWAR DR
Practice Address - Street 2:#207
Practice Address - City:ROCK SPRINGS
Practice Address - State:WY
Practice Address - Zip Code:82901-5773
Practice Address - Country:US
Practice Address - Phone:307-382-3058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-05
Last Update Date:2010-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLPC 642101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional