Individual
MATHEW AVERY MAYES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC-IT, SAC-IT
Contact information
Practice address
1205 S 70TH ST, STE. 301, 1205, WEST ALLIS, WI 53214-3167
(414) 531-5207
Mailing address
6233 39TH AVE, KENOSHA, WI 53142-7015
(262) 652-1004
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
7265-226
WI
Other
Enumeration date
06/13/2023
Last updated
06/13/2023
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