Provider Demographics
NPI:1144678830
Name:CASAL, MAYELLY ALEXANDRA (LMHC)
Entity type:Individual
Prefix:
First Name:MAYELLY
Middle Name:ALEXANDRA
Last Name:CASAL
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 1:6700 S FLORIDA AVE STE 27
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-3312
Mailing Address - Country:US
Mailing Address - Phone:863-660-7915
Mailing Address - Fax:186-627-8161
Practice Address - Street 1:6700 S FLORIDA AVE STE 27
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-3312
Practice Address - Country:US
Practice Address - Phone:863-660-7915
Practice Address - Fax:186-627-8161
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-02
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH12062101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health