MEDICARE: JOHN BENJAMIN 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	101YP2500X	Professional Counselor	MH 0411	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801181300
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN BENJAMIN MAYO LMHC

Provider Business Mailing Address
First Line	:	1311 N WESTSHORE BLVD
Second Line	:	SUITE 302
City	:	TAMPA
State	:	FL
Zip	:	33607-4602
Country	:	US
Telephone Number	:	813-490-5490
Fax Number	:	813-490-5495

Provider Business Practice Location Address
First Line	:	1311 N WESTSHORE BLVD
Second Line	:	SUITE 302
City	:	TAMPA
State	:	FL
Zip	:	33607-4602
Country	:	US
Telephone Number	:	813-490-5490
Fax Number	:	813-490-5495

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

Provider Enumeration Date	:	06/13/2011
Last Update Date	:	06/13/2011

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