Provider Demographics
NPI:1164080123
Name:MAYFIELD, DREAMOR (LPC)
Entity Type:Individual
Prefix:
First Name:DREAMOR
Middle Name:
Last Name:MAYFIELD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:DREAMOR
Other - Middle Name:
Other - Last Name:MAYFIELD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:636 APPLE CROSS CT
Mailing Address - Street 2:
Mailing Address - City:ROBINSON
Mailing Address - State:TX
Mailing Address - Zip Code:76706-5341
Mailing Address - Country:US
Mailing Address - Phone:254-413-0640
Mailing Address - Fax:
Practice Address - Street 1:6600 SANGER AVE STE 21
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-7805
Practice Address - Country:US
Practice Address - Phone:254-413-0640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-04
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX74201101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1164080123Medicaid