Provider Demographics
NPI:1245194885
Name:MAYO, CLIFFARD D (MBA, MS, LAC)
Entity type:Individual
Prefix:
First Name:CLIFFARD
Middle Name:D
Last Name:MAYO
Suffix:
Gender:M
Credentials:MBA, MS, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5554 S PROSPECT CREEK RD
Mailing Address - Street 2:
Mailing Address - City:FORT MOHAVE
Mailing Address - State:AZ
Mailing Address - Zip Code:86426-1234
Mailing Address - Country:US
Mailing Address - Phone:520-921-0921
Mailing Address - Fax:
Practice Address - Street 1:5554 S PROSPECT CREEK RD
Practice Address - Street 2:
Practice Address - City:FORT MOHAVE
Practice Address - State:AZ
Practice Address - Zip Code:86426-1234
Practice Address - Country:US
Practice Address - Phone:520-921-0921
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-12-09
Last Update Date:2025-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-23631101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health