Provider Demographics
NPI:1639243033
Name:MAYFIELD, LISA DEROSIER (LMHC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:DEROSIER
Last Name:MAYFIELD
Suffix:
Gender:F
Credentials:LMHC
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 31175
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-1175
Mailing Address - Country:US
Mailing Address - Phone:206-660-3276
Mailing Address - Fax:866-464-8906
Practice Address - Street 1:701 DEXTER AVE N STE 300
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-4342
Practice Address - Country:US
Practice Address - Phone:206-660-3276
Practice Address - Fax:866-464-8906
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00007998101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health