Provider Demographics
NPI:1104383405
Name:MAYFIELD, SHANTEE L (LPC)
Entity Type:Individual
Prefix:DR
First Name:SHANTEE
Middle Name:L
Last Name:MAYFIELD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:DR
Other - First Name:TEE
Other - Middle Name:L
Other - Last Name:MAYFIELD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:2665 VILLA CREEK DR STE 105
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75234-7356
Mailing Address - Country:US
Mailing Address - Phone:945-232-7884
Mailing Address - Fax:
Practice Address - Street 1:2665 VILLA CREEK DR STE 105
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75234-7356
Practice Address - Country:US
Practice Address - Phone:945-232-7884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-23
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
TX77647101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health