Provider Demographics
NPI:1548681810
Name:MAYLAND, TERILYN
Entity type:Individual
Prefix:
First Name:TERILYN
Middle Name:
Last Name:MAYLAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TERILYN
Other - Middle Name:
Other - Last Name:MAYLAND
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1841 MADORA AVE
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:WY
Mailing Address - Zip Code:82633-3057
Mailing Address - Country:US
Mailing Address - Phone:307-358-2846
Mailing Address - Fax:307-358-5329
Practice Address - Street 1:1841 MADORA AVE
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:WY
Practice Address - Zip Code:82633-3057
Practice Address - Country:US
Practice Address - Phone:307-358-2846
Practice Address - Fax:307-358-5329
Is Sole Proprietor?:No
Enumeration Date:2014-01-03
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPAT-065101YA0400X
WYCAP-184101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY1225003023Medicaid
WY1932229523Medicaid