Provider Demographics
NPI:1760094080
Name:MAYFIELD, MEGAN ALEXIS (LMSW)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:ALEXIS
Last Name:MAYFIELD
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:ALEXIS
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:103 EL NATHAN DRIVE
Mailing Address - Street 2:
Mailing Address - City:MARBLE HILL
Mailing Address - State:MO
Mailing Address - Zip Code:63764-8342
Mailing Address - Country:US
Mailing Address - Phone:573-238-1027
Mailing Address - Fax:573-238-1171
Practice Address - Street 1:103 EL NATHAN DRIVE
Practice Address - Street 2:
Practice Address - City:MARBLE HILL
Practice Address - State:MO
Practice Address - Zip Code:63764-8342
Practice Address - Country:US
Practice Address - Phone:573-238-1027
Practice Address - Fax:573-238-1171
Is Sole Proprietor?:No
Enumeration Date:2020-08-18
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020024786104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker