Michael Ray Maynard

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

APCC9197 Issued in CA

Practice address

7828 Day Creek Blvd Apt 131
Rancho Cucamonga, CA 91739-8570

Phone

(909) 438-0351

Fax

(909) 438-0351

NPI assigned

Aug 29, 2009

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Ehab Yacoub MD IncGroup PAC ID 5092099523, 179 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Ehab Yacoub MD Inc.

  • Child & Adolescent Psychiatry Physician
  • Gardena, CA
  • NPI 1417373713
  Medicare reassignment Care Compare group NPD
• The Brain Balance Center Inc

  • Marriage & Family Therapist
  • Owasso, OK
  • NPI 1205540275
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1251504000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664755200000",
    "number": "1205069812",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7828 DAY CREEK BLVD APT 131",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917398570",
            "telephone_number": "909-438-0351",
            "fax_number": "909-438-0351"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7828 DAY CREEK BLVD APT 131",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917398570",
            "telephone_number": "909-438-0351",
            "fax_number": "909-438-0351"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "125 W F St",
            "address_purpose": "LOCATION",
            "city": "Ontario",
            "state": "CA",
            "postal_code": "917623262",
            "country_code": "US",
            "telephone_number": "909-986-4550",
            "fax_number": "909-986-4506",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MAYNARD",
        "first_name": "MICHAEL",
        "middle_name": "RAY",
        "name_prefix": "Mr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-08-29",
        "last_updated": "2022-10-03",
        "certification_date": "2022-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "APCC9197",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Astrid Yajaira Matzar-Sanchez
• Graziano Mario Mauriz, LCSW
• Frances Maximea
• Lori Mayer
• Alexis Mayfield
• Deborah Mayo
• Dimitrius Mayo III
• Dimitrius Mayo Jr.
• Lynnea Mayorga
• Stephanie Paola Mayorga

• Mental Health Counselor in Rancho Cucamonga, CA
• Providers in Rancho Cucamonga, CA by specialty
• Mental Health Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.