Provider Demographics
NPI:1568846814
Name:MAYFIELD COUNSELING
Entity Type:Organization
Organization Name:MAYFIELD COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND CLINICAL SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:AARON
Authorized Official - Last Name:MAYFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-439-8014
Mailing Address - Street 1:6180 LEHMAN DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-3444
Mailing Address - Country:US
Mailing Address - Phone:719-439-8014
Mailing Address - Fax:
Practice Address - Street 1:6180 LEHMAN DR
Practice Address - Street 2:SUITE 100
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-3444
Practice Address - Country:US
Practice Address - Phone:719-439-8014
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-16
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0011420101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty