Provider Demographics
NPI:1841628484
Name:MAESTAS, MAURIE E (MHP)
Entity type:Individual
Prefix:MRS
First Name:MAURIE
Middle Name:E
Last Name:MAESTAS
Suffix:
Gender:F
Credentials:MHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 W GLAZYPEAU RD
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71909-9561
Mailing Address - Country:US
Mailing Address - Phone:501-984-1971
Mailing Address - Fax:
Practice Address - Street 1:2607 CADDO ST
Practice Address - Street 2:SUITE 6
Practice Address - City:ARKADELPHIA
Practice Address - State:AR
Practice Address - Zip Code:71923-5307
Practice Address - Country:US
Practice Address - Phone:870-230-8217
Practice Address - Fax:870-230-8201
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-16
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
ARA1411147101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst