Provider Information for 1568842805
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MAUREEN MICHAEL MS LPC
Other Names:Former Name:MAUREEN REILLYSex: Female
NPI: 1568842805
Last Updated: 2021-10-04
Certification Date: 2021-10-04
Certification Date: 2021-10-04
Details
| Name | Value | ||||||||||||
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| NPI | 1568842805 | ||||||||||||
| Enumeration Date | 2015-06-02 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | NO | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 711 S GRANITE ST PRESCOTT, AZ 86303-4241 United States Phone: 928-863-8703 | Fax:928-515-2416 | ||||||||||||
| Primary Practice Address | 711 S GRANITE ST PRESCOTT, AZ 86303-4241 United States Phone: 928-493-4373 | Fax:928-515-2416 | ||||||||||||
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