Maydai Trauma Focused Clinical Network and Research Center LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

MAYDAI TRAUMA FOCUSED CLINICAL NETWORK AND RESEARCH CENTER LLC

Practice address

4601 State St Ste 220
East Saint Louis, IL 62205-1359

Phone

(618) 741-9635

NPI assigned

Aug 18, 2021

Organization subpart

No

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

Authorized official

Name

Mr. Kory L May, LCSW

Title

Ceo/President

Phone

(618) 741-9635

Specialties & licenses 10

Addresses

Locations

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

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    "created_epoch": "1629244800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1635465600000",
    "number": "1659047744",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3144 VIRGINIA PL",
            "city": "EAST SAINT LOUIS",
            "state": "IL",
            "postal_code": "622071759",
            "telephone_number": "618-741-9635"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4601 STATE ST STE 220",
            "city": "EAST SAINT LOUIS",
            "state": "IL",
            "postal_code": "622051359",
            "telephone_number": "618-741-9635"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAYDAI TRAUMA FOCUSED CLINICAL NETWORK AND RESEARCH CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-18",
        "last_updated": "2021-10-29",
        "certification_date": "2021-10-29",
        "status": "A",
        "authorized_official_last_name": "MAY",
        "authorized_official_first_name": "KORY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CEO/PRESIDENT",
        "authorized_official_telephone_number": "618-741-9635",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TP2701X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Group Psychotherapy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "163WP0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse, Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "405300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Prevention Professional",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John M Magner, MD
• Jordan Kenneth Marshall, MD
• Mary Advocacy Center
• Mary Advocacy Center
• Kelli J May, FNP-C
• Chontay L McKay, FNP-C
• Med East SC
• Medicate Pharmacy Shoppes Inc
• Medicate Pharmacy, Inc
• Terica Meeks, NP

• Clinical Social Worker in East Saint Louis, IL
• Providers in East Saint Louis, IL by specialty
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.