Provider Demographics
NPI:1740852706
Name:MAYO, TEOSHA
Entity type:Individual
Prefix:
First Name:TEOSHA
Middle Name:
Last Name:MAYO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 E TRAVIS ST
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:TX
Mailing Address - Zip Code:75670-4258
Mailing Address - Country:US
Mailing Address - Phone:903-402-5103
Mailing Address - Fax:
Practice Address - Street 1:505 E TRAVIS ST STE 208
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:TX
Practice Address - Zip Code:75670-4281
Practice Address - Country:US
Practice Address - Phone:832-562-8255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-10
Last Update Date:2023-11-14
Deactivation Date:2022-03-08
Deactivation Code:
Reactivation Date:2023-11-14
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator