Healthcare Provider Details

I. General information

NPI: 1386229763
Provider Name (Legal Business Name): MYCHAELLA MAYO AMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2021
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 N COURT ST
VISALIA CA
93291-3638
US

IV. Provider business mailing address

711 N COURT ST
VISALIA CA
93291-3638
US

V. Phone/Fax

Practice location:
  • Phone: 559-627-1490
  • Fax:
Mailing address:
  • Phone: 559-627-1490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number154973
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: