Doctor Name: | PETER L MAYO |
NPI Number: | 1154529196 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LPC |
License Number: | 3461-125 |
Business Practice Address: | 130 Main Street Suite 200 Menasha, WI - 54952 |
Business Phone Number: | 9203797769 |
Business Fax Number: | |
Mailing Address: | 130 Main Street, Suite 200 MENASHA |
State: | WI |
Postal Code: | 54952 |
Phone Number: | 9203797769 |
Fax Number: | |
NPI Enumeration Date: | 07/10/2007 |
NPI Last Update Date: | 05/25/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 3461-125 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |