Provider Demographics
NPI:1538814694
Name:MAYO, LAUREL ANN (RADT)
Entity type:Individual
Prefix:
First Name:LAUREL
Middle Name:ANN
Last Name:MAYO
Suffix:
Gender:F
Credentials:RADT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 W VISTA WAY
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92083-5704
Mailing Address - Country:US
Mailing Address - Phone:760-940-1836
Mailing Address - Fax:
Practice Address - Street 1:504 W VISTA WAY
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083-5704
Practice Address - Country:US
Practice Address - Phone:760-940-1836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-17
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program