Provider Demographics
NPI:1083268627
Name:MAYO, NICOLE A (MA)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:A
Last Name:MAYO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3655 COOPER NICHOLSON RD
Mailing Address - Street 2:
Mailing Address - City:PLEASANT VIEW
Mailing Address - State:TN
Mailing Address - Zip Code:37146-9028
Mailing Address - Country:US
Mailing Address - Phone:931-378-2124
Mailing Address - Fax:
Practice Address - Street 1:3655 COOPER NICHOLSON RD
Practice Address - Street 2:
Practice Address - City:PLEASANT VIEW
Practice Address - State:TN
Practice Address - Zip Code:37146-9028
Practice Address - Country:US
Practice Address - Phone:931-378-2124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-31
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
No103T00000XBehavioral Health & Social Service ProvidersPsychologist