Provider Demographics
NPI:1831857879
Name:MAUZAY, DAKOTA (PY)
Entity type:Individual
Prefix:
First Name:DAKOTA
Middle Name:
Last Name:MAUZAY
Suffix:
Gender:M
Credentials:PY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 SE PROFESSIONAL MALL BLVD STE 204
Mailing Address - Street 2:
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99163-5423
Mailing Address - Country:US
Mailing Address - Phone:509-570-3302
Mailing Address - Fax:
Practice Address - Street 1:1205 SE PROFESSIONAL MALL BLVD STE 204
Practice Address - Street 2:
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99163-5423
Practice Address - Country:US
Practice Address - Phone:509-570-3302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-07
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61247046103TC0700X, 103TC0700X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor