Provider Demographics
NPI:1790838142
Name:MAYO, MICKEY (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MICKEY
Middle Name:
Last Name:MAYO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5031
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71361-5031
Mailing Address - Country:US
Mailing Address - Phone:318-484-6255
Mailing Address - Fax:318-484-6298
Practice Address - Street 1:242 W SHAMROCK AVE.
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360
Practice Address - Country:US
Practice Address - Phone:318-484-6255
Practice Address - Fax:318-484-6298
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA22091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical