Healthcare Provider Details

I. General information

NPI: 1023454352
Provider Name (Legal Business Name): ROBIN LYNN MAYO BA, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2013
Last Update Date: 05/01/2025
Certification Date: 05/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 E NATCHEZ ST
BROKEN ARROW OK
74011-8800
US

IV. Provider business mailing address

508 E NATCHEZ ST
BROKEN ARROW OK
74011-8800
US

V. Phone/Fax

Practice location:
  • Phone: 918-260-7605
  • Fax:
Mailing address:
  • Phone: 918-260-7605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6391
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: