Provider Demographics
NPI:1689992612
Name:MAYFIELD, KARA ANNE
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:ANNE
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:RR 1 BOX 186
Mailing Address - Street 2:
Mailing Address - City:SALLISAW
Mailing Address - State:OK
Mailing Address - Zip Code:74955-9753
Mailing Address - Country:US
Mailing Address - Phone:806-676-1379
Mailing Address - Fax:
Practice Address - Street 1:RR 1 BOX 186
Practice Address - Street 2:
Practice Address - City:SALLISAW
Practice Address - State:OK
Practice Address - Zip Code:74955-9753
Practice Address - Country:US
Practice Address - Phone:806-676-1379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-14
Last Update Date:2010-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health