Provider Demographics
NPI:1538695135
Name:MAYFIELD, PETER
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:MAYFIELD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 995
Mailing Address - Street 2:
Mailing Address - City:SODA SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:95728-0995
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11500 DONNER PASS RD
Practice Address - Street 2:SUITE C
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161-4947
Practice Address - Country:US
Practice Address - Phone:530-426-2110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-03
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health