Provider Demographics
NPI:1720365604
Name:MAYO, GARY
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:
Last Name:MAYO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3109 TUDOR ROAD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73122-1343
Mailing Address - Country:US
Mailing Address - Phone:405-948-1169
Mailing Address - Fax:
Practice Address - Street 1:3109 TUDOR ROAD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73122-1343
Practice Address - Country:US
Practice Address - Phone:405-948-1169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-07
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor