Provider Demographics
NPI:1235442013
Name:MAYFIELD, CRYSTAL R (BSW, CADC, CSS)
Entity Type:Individual
Prefix:MS
First Name:CRYSTAL
Middle Name:R
Last Name:MAYFIELD
Suffix:
Gender:F
Credentials:BSW, CADC, CSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3107 CINCINNATI RD
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-9505
Mailing Address - Country:US
Mailing Address - Phone:502-570-9313
Mailing Address - Fax:
Practice Address - Street 1:3107 CINCINNATI RD
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-9505
Practice Address - Country:US
Practice Address - Phone:502-570-9313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-21
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0898101YA0400X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker