Provider Demographics
NPI:1922101997
Name:MAYO, SUE (MFT)
Entity Type:Individual
Prefix:MS
First Name:SUE
Middle Name:
Last Name:MAYO
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3184 OLD TUNNEL RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:LAFAYETTE
Mailing Address - State:CA
Mailing Address - Zip Code:94549-4153
Mailing Address - Country:US
Mailing Address - Phone:925-284-0699
Mailing Address - Fax:
Practice Address - Street 1:3184 OLD TUNNEL RD STE D
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549-4153
Practice Address - Country:US
Practice Address - Phone:925-284-0699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC37211106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist