| Doctor Name: | ENGELBERT MITTERMAYR |
| NPI Number: | 1093169229 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | CRC, LAC |
| License Number: | LAC-16020 |
| Business Practice Address: | 20987 N John Wayne Pkwy Ste B104 # 208 Maricopa, AZ - 851392926 |
| Business Phone Number: | 6028121334 |
| Business Fax Number: | |
| Mailing Address: | 20987 N John Wayne Pkwy, Ste B104 # 208 MARICOPA |
| State: | AZ |
| Postal Code: | 851392926 |
| Phone Number: | 6028121334 |
| Fax Number: | |
| NPI Enumeration Date: | 04/13/2016 |
| NPI Last Update Date: | 04/13/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | LAC-16020 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AZ |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |