Provider Demographics
NPI:1912287772
Name:MAYSURA, MICHAEL (BSW)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:MAYSURA
Suffix:
Gender:M
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28000 DEQUINDRE RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48092-2468
Mailing Address - Country:US
Mailing Address - Phone:586-753-1028
Mailing Address - Fax:586-753-1088
Practice Address - Street 1:1515 N STEPHENSON HWY
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-1526
Practice Address - Country:US
Practice Address - Phone:248-542-6070
Practice Address - Fax:248-542-3210
Is Sole Proprietor?:No
Enumeration Date:2011-08-25
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor