Basic Information
| Provider Information | |||||||||
| NPI: | 1114410586 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MAYLES | ||||||||
| FirstName: | PHILIP | ||||||||
| MiddleName: | ANDREW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1241 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | HARRISONBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 228024632 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5404341941 | ||||||||
| FaxNumber: | 5404340132 | ||||||||
| Practice Location | |||||||||
| Address1: | 1241 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | HARRISONBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 22802 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5404341941 | ||||||||
| FaxNumber: | 5404340132 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2018 | ||||||||
| LastUpdateDate: | 05/08/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/08/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 0701007222 | VA | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.