Individual
ALBERT E MAYO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
912 S. ERVAY, DALLAS, TX 75201
(214) 478-8379
(972) 581-4313
Mailing address
430 PRATT RD, RED OAK, TX 75154-5228
(214) 478-8379
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
31003
TX
103TC0700X
Clinical Psychologist
31003
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
307679608
—
TX
01
—
307679609
MEDICAID CSHCN
TX
01
—
89440A
BLUE CROSS BLUE SHIELD NUMBER
TX
Enumeration date
10/05/2012
Last updated
05/03/2016
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