Provider Demographics
NPI:1023177177
Name:MAY, MIRA M (LCSW)
Entity type:Individual
Prefix:
First Name:MIRA
Middle Name:M
Last Name:MAY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MIRA
Other - Middle Name:M
Other - Last Name:MAY-MULLINS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSSW LSW
Mailing Address - Street 1:PO BOX 10299
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46851-0299
Mailing Address - Country:US
Mailing Address - Phone:574-546-1900
Mailing Address - Fax:574-546-1999
Practice Address - Street 1:2100 N MAIN ST STE 304
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-1877
Practice Address - Country:US
Practice Address - Phone:574-546-1900
Practice Address - Fax:574-546-1999
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical