Provider Demographics
NPI:1649915737
Name:MAVERICK MENTAL HEALTH, PLLC
Entity type:Organization
Organization Name:MAVERICK MENTAL HEALTH, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:E
Authorized Official - Last Name:ELM
Authorized Official - Suffix:
Authorized Official - Credentials:LISW, BC-TMH
Authorized Official - Phone:612-749-3746
Mailing Address - Street 1:3425 HOLIDAY CT APT 2
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-6702
Mailing Address - Country:US
Mailing Address - Phone:612-749-3746
Mailing Address - Fax:
Practice Address - Street 1:3425 HOLIDAY CT APT 2
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-6702
Practice Address - Country:US
Practice Address - Phone:612-749-3746
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-03
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty