Provider Demographics
NPI:1356423610
Name:MAHER, MIC HAEL J (MS, LMHC)
Entity type:Individual
Prefix:MR
First Name:MIC HAEL
Middle Name:J
Last Name:MAHER
Suffix:
Gender:M
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1522 MORGAN ST
Mailing Address - Street 2:
Mailing Address - City:KEOKUK
Mailing Address - State:IA
Mailing Address - Zip Code:52632-4028
Mailing Address - Country:US
Mailing Address - Phone:319-524-0510
Mailing Address - Fax:319-524-0609
Practice Address - Street 1:1522 MORGAN ST
Practice Address - Street 2:
Practice Address - City:KEOKUK
Practice Address - State:IA
Practice Address - Zip Code:52632-4028
Practice Address - Country:US
Practice Address - Phone:319-524-0510
Practice Address - Fax:319-524-0609
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA183101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health