Provider Demographics
NPI:1801181300
Name:MAYO, JOHN BENJAMIN (LMHC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:BENJAMIN
Last Name:MAYO
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1311 N WESTSHORE BLVD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-4602
Mailing Address - Country:US
Mailing Address - Phone:813-490-5490
Mailing Address - Fax:813-490-5495
Practice Address - Street 1:1311 N WESTSHORE BLVD
Practice Address - Street 2:SUITE 302
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-4602
Practice Address - Country:US
Practice Address - Phone:813-490-5490
Practice Address - Fax:813-490-5495
Is Sole Proprietor?:No
Enumeration Date:2011-06-13
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 0411101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL767153900Medicaid