Provider Demographics
NPI:1750024469
Name:MAYO, SHELLBY TAYLOR (LPC)
Entity Type:Individual
Prefix:
First Name:SHELLBY
Middle Name:TAYLOR
Last Name:MAYO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2627 CALLE DE MERCADO APT 10
Mailing Address - Street 2:
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86442-7970
Mailing Address - Country:US
Mailing Address - Phone:928-542-1598
Mailing Address - Fax:
Practice Address - Street 1:2580 HWAY 95 STE 120
Practice Address - Street 2:
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-7328
Practice Address - Country:US
Practice Address - Phone:928-763-7776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-20
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-20485101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional