| Doctor Name: | MR. SCOTT LEE MAYNARD |
| NPI Number: | 1659395150 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LMSW |
| License Number: | 068309 |
| Business Practice Address: | 559 Vincent St Attn: 21 Mdos/sgoh--mental Health Peterson Afb, CO - 809141541 |
| Business Phone Number: | 7195567804 |
| Business Fax Number: | |
| Mailing Address: | 559 Vincent St, Attn: 21 Mdos/sgoh--mental Health PETERSON AFB |
| State: | CO |
| Postal Code: | 809141541 |
| Phone Number: | 7195567804 |
| Fax Number: | |
| NPI Enumeration Date: | 07/27/2006 |
| NPI Last Update Date: | 03/13/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 068309 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |