Provider Demographics
NPI:1922478080
Name:CHENAULT, MAYIA RANEESE
Entity Type:Individual
Prefix:
First Name:MAYIA
Middle Name:RANEESE
Last Name:CHENAULT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48501 S I 94 SERVCE DR APT 107
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48111-1763
Mailing Address - Country:US
Mailing Address - Phone:313-421-7180
Mailing Address - Fax:
Practice Address - Street 1:48501 S I 94 SERVCE DR APT 107
Practice Address - Street 2:
Practice Address - City:VAN BUREN TWP
Practice Address - State:MI
Practice Address - Zip Code:48111
Practice Address - Country:US
Practice Address - Phone:313-421-7180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-01
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X, 247200000X
MI1-18-32993103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other