MEDICARE: MR. MOSES AARON MAYLOR SR. M.A.

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	IMH-1424	FL

General Provider Information

NPI Number	:	1407164965
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MOSES AARON MAYLOR SR. M.A.

Provider Business Mailing Address
First Line	:	1350 N ORANGE AVE
Second Line	:	223
City	:	WINTER PARK
State	:	FL
Zip	:	32789-4945
Country	:	US
Telephone Number	:	407-644-4367
Fax Number	:	407-622-1200

Provider Business Practice Location Address
First Line	:	1350 N ORANGE AVE
Second Line	:	223
City	:	WINTER PARK
State	:	FL
Zip	:	32789-4945
Country	:	US
Telephone Number	:	407-644-4367
Fax Number	:	407-622-1200

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

Provider Enumeration Date	:	09/18/2010
Last Update Date	:	09/18/2010

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