Provider Demographics
NPI:1366998148
Name:LISA ANN MAYNES FIRST STEPS PROVIDER
Entity type:Organization
Organization Name:LISA ANN MAYNES FIRST STEPS PROVIDER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TEACHER DEVELOPMENT INTERVENTIST
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MAYNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-521-7045
Mailing Address - Street 1:348 S HIGHWAY 1223
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40701-4643
Mailing Address - Country:US
Mailing Address - Phone:606-521-7045
Mailing Address - Fax:
Practice Address - Street 1:348 S HIGHWAY 1223
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-4643
Practice Address - Country:US
Practice Address - Phone:606-521-7045
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-31
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency