Provider Demographics
NPI:1982489266
Name:MAYO ROLLER, MARICELA (LMFT)
Entity Type:Individual
Prefix:
First Name:MARICELA
Middle Name:
Last Name:MAYO ROLLER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:MARICELA
Other - Middle Name:CASTRO
Other - Last Name:MAYO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:1168 NAVASOTA ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78702-1948
Mailing Address - Country:US
Mailing Address - Phone:512-484-2548
Mailing Address - Fax:
Practice Address - Street 1:2520 LONGVIEW ST STE 213
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-4234
Practice Address - Country:US
Practice Address - Phone:512-270-0199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-25
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX204065106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist