Provider Demographics
NPI:1255171922
Name:MAYFIELD ENTERPRISES
Entity type:Organization
Organization Name:MAYFIELD ENTERPRISES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER / THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KRISPIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:971-255-3220
Mailing Address - Street 1:19013 NE COUCH LN
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97230-7861
Mailing Address - Country:US
Mailing Address - Phone:971-255-3220
Mailing Address - Fax:
Practice Address - Street 1:19013 NE COUCH LN
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97230-7861
Practice Address - Country:US
Practice Address - Phone:971-255-3220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-29
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty