Provider Demographics
NPI:1033786942
Name:MAYOTTE, ARLENE FAITH
Entity Type:Individual
Prefix:
First Name:ARLENE
Middle Name:FAITH
Last Name:MAYOTTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14510 JAMES VINCENT DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78725-4747
Mailing Address - Country:US
Mailing Address - Phone:508-241-4114
Mailing Address - Fax:
Practice Address - Street 1:BLDG 30003
Practice Address - Street 2:SUPPORT AVENUE
Practice Address - City:FT. HOOD
Practice Address - State:TX
Practice Address - Zip Code:76544
Practice Address - Country:US
Practice Address - Phone:254-553-7437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-09
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA111452163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult