Provider Demographics
NPI:1205228541
Name:MAES, PHILIP JONATHAN (MA, LMFT)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:JONATHAN
Last Name:MAES
Suffix:
Gender:M
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1015
Mailing Address - Street 2:
Mailing Address - City:SALIDA
Mailing Address - State:CO
Mailing Address - Zip Code:81201-1015
Mailing Address - Country:US
Mailing Address - Phone:719-530-1224
Mailing Address - Fax:
Practice Address - Street 1:13 SILVER SPRUCE DR
Practice Address - Street 2:
Practice Address - City:SALIDA
Practice Address - State:CO
Practice Address - Zip Code:81201-9483
Practice Address - Country:US
Practice Address - Phone:719-530-1224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-24
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLMFT 355106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist