Provider Demographics
NPI:1124375563
Name:MAYO, GERALD LOU III (MSW, PLMHP)
Entity type:Individual
Prefix:MR
First Name:GERALD
Middle Name:LOU
Last Name:MAYO
Suffix:III
Gender:M
Credentials:MSW, PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:917 W 21ST ST
Mailing Address - Street 2:P.O. BOX 355
Mailing Address - City:SOUTH SIOUX CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68776-2652
Mailing Address - Country:US
Mailing Address - Phone:402-494-3337
Mailing Address - Fax:402-494-3356
Practice Address - Street 1:917 W 21ST ST
Practice Address - Street 2:
Practice Address - City:SOUTH SIOUX CITY
Practice Address - State:NE
Practice Address - Zip Code:68776-2652
Practice Address - Country:US
Practice Address - Phone:402-494-3337
Practice Address - Fax:402-494-3356
Is Sole Proprietor?:No
Enumeration Date:2012-08-03
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE9719101YM0800X
NE68221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical