Provider Demographics
NPI:1932388584
Name:MAYO, VINCENT WILLIAM
Entity Type:Individual
Prefix:MR
First Name:VINCENT
Middle Name:WILLIAM
Last Name:MAYO
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:VINCENT
Other - Middle Name:WILLIAM
Other - Last Name:MAYO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:611 HIGGINS ST
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OK
Mailing Address - Zip Code:73448-1401
Mailing Address - Country:US
Mailing Address - Phone:580-276-5328
Mailing Address - Fax:
Practice Address - Street 1:93 BROADLAWN
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401
Practice Address - Country:US
Practice Address - Phone:580-223-2537
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-31
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health