MEDICARE: AOLANI MAYO LMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	MH24170	FL

General Provider Information

NPI Number	:	1164259529
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AOLANI MAYO LMHC

Provider Business Mailing Address
First Line	:	1501 ROBERT J CONLAN BLVD NE STE 7
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32905-3559
Country	:	US
Telephone Number	:	321-372-6897
Fax Number	:	321-372-6896

Provider Business Practice Location Address
First Line	:	1501 ROBERT J CONLAN BLVD NE STE 7
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32905-3559
Country	:	US
Telephone Number	:	321-372-6897
Fax Number	:	321-372-6896

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/18/2024
Last Update Date	:	09/18/2024

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