Doctor Name: | MARY LANAE AYERS |
NPI Number: | 1053581066 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.A. RC |
License Number: | RC00040097 |
Business Practice Address: | 4115 Bridgeport Way W Suite C University Place, WA - 984664331 |
Business Phone Number: | 2063009639 |
Business Fax Number: | 2535645603 |
Mailing Address: | 4115 Bridgeport Way W, Suite C UNIVERSITY PLACE |
State: | WA |
Postal Code: | 984664331 |
Phone Number: | 2063009639 |
Fax Number: | 2535645603 |
NPI Enumeration Date: | 03/05/2008 |
NPI Last Update Date: | 03/05/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | RC00040097 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |