Provider Demographics
NPI:1275981771
Name:MAYFIELD, DONNA
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:MAYFIELD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1880 SE COLE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:KS
Mailing Address - Zip Code:67042-9109
Mailing Address - Country:US
Mailing Address - Phone:316-641-4403
Mailing Address - Fax:
Practice Address - Street 1:1880 SE COLE CREEK RD
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:KS
Practice Address - Zip Code:67042-9109
Practice Address - Country:US
Practice Address - Phone:316-641-4403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-25
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
171000000XOtherCOMMUNITY MENTAL HEALTH CENTER
172V00000XOtherCOMMUNITY MENTAL HEALTH CENTER
KS461928417OtherBEHAVIOR HEALTH PROVIDER IN THE COMMUNITY