Provider Demographics
NPI:1811157712
Name:MAYES, MICHAEL H
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:H
Last Name:MAYES
Suffix:
Gender:M
Credentials:
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 1401
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97339-1401
Mailing Address - Country:US
Mailing Address - Phone:503-480-5086
Mailing Address - Fax:
Practice Address - Street 1:4719 SW ROSEBERRY ST
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97333-1793
Practice Address - Country:US
Practice Address - Phone:503-480-5086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-13
Last Update Date:2014-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No104100000XBehavioral Health & Social Service ProvidersSocial Worker