Individual
MISTY MAYLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
207D COLEGATE DR, MARIETTA, OH 45750-2363
(403) 760-9307
(740) 376-0933
Mailing address
207D COLEGATE DR, MARIETTA, OH 45750-2363
(403) 760-9307
(740) 376-0933
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2314525
—
OH
05
—
2864002
—
OH
Enumeration date
10/01/2018
Last updated
08/29/2019
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