Provider Demographics
NPI:1679639645
Name:MAYFIELD, KATJA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KATJA
Middle Name:
Last Name:MAYFIELD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2672 CABALLO CT
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-9000
Mailing Address - Country:US
Mailing Address - Phone:575-571-2743
Mailing Address - Fax:575-521-9215
Practice Address - Street 1:1990 E LOHMAN AVE STE 225
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-3172
Practice Address - Country:US
Practice Address - Phone:575-571-2743
Practice Address - Fax:575-521-9215
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2017-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC-36441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000000S0568Medicaid
NM10075381Medicaid
NM10075381Medicaid