Provider Demographics
NPI:1407164965
Name:MAYLOR, MOSES AARON SR (MA)
Entity Type:Individual
Prefix:MR
First Name:MOSES
Middle Name:AARON
Last Name:MAYLOR
Suffix:SR
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1350 N ORANGE AVE
Mailing Address - Street 2:223
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-4945
Mailing Address - Country:US
Mailing Address - Phone:407-644-4367
Mailing Address - Fax:407-622-1200
Practice Address - Street 1:1350 N ORANGE AVE
Practice Address - Street 2:223
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-4945
Practice Address - Country:US
Practice Address - Phone:407-644-4367
Practice Address - Fax:407-622-1200
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-18
Last Update Date:2010-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH-1424101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health