Provider Demographics
NPI:1790527885
Name:MAYO THERAPEUTIC INTERVENTIONS LLC
Entity type:Organization
Organization Name:MAYO THERAPEUTIC INTERVENTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYO
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, NCC
Authorized Official - Phone:770-653-4531
Mailing Address - Street 1:309 PIRKLE FERRY RD STE C200
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-2550
Mailing Address - Country:US
Mailing Address - Phone:770-653-4531
Mailing Address - Fax:770-764-1265
Practice Address - Street 1:309 PIRKLE FERRY RD STE C200
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-2550
Practice Address - Country:US
Practice Address - Phone:770-653-4531
Practice Address - Fax:770-764-1265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)