Provider Demographics
NPI:1881131746
Name:CEBALLO, MAYELIN (LMHC)
Entity type:Individual
Prefix:MR
First Name:MAYELIN
Middle Name:
Last Name:CEBALLO
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14966 SW 75 TERRACE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-2395
Mailing Address - Country:US
Mailing Address - Phone:786-269-7528
Mailing Address - Fax:
Practice Address - Street 1:14966 SW 75TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33193-2395
Practice Address - Country:US
Practice Address - Phone:786-269-7528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-30
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
FLMH19844101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health