Provider Demographics
NPI:1134985724
Name:MAYOR MENTAL HEALTH, LLC
Entity type:Organization
Organization Name:MAYOR MENTAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:MICAELA
Authorized Official - Last Name:MAYOR
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:850-737-1031
Mailing Address - Street 1:1992 LEWIS TURNER BLVD STE 1126
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-1255
Mailing Address - Country:US
Mailing Address - Phone:850-367-7453
Mailing Address - Fax:
Practice Address - Street 1:1992 LEWIS TURNER BLVD STE 1126
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-1255
Practice Address - Country:US
Practice Address - Phone:850-367-7453
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-22
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)