Doctor Name: | MANUEL GEORGE MAES |
NPI Number: | 1013346717 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | CAC III |
License Number: | ACC0007018 |
Business Practice Address: | 1006 S Main St Lamar, CO - 810523814 |
Business Phone Number: | 7193832600 |
Business Fax Number: | 7193363669 |
Mailing Address: | 1006 S Main St, LAMAR |
State: | CO |
Postal Code: | 810523814 |
Phone Number: | 7193832600 |
Fax Number: | 7193363669 |
NPI Enumeration Date: | 11/04/2013 |
NPI Last Update Date: | 11/04/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | ACC0007018 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CO |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |