Provider Demographics
NPI:1295050904
Name:MAYFIELD, COURTNEY LEE (LPC)
Entity type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:LEE
Last Name:MAYFIELD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:LEE
Other - Last Name:CASARES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 72
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:TX
Mailing Address - Zip Code:76634-0072
Mailing Address - Country:US
Mailing Address - Phone:254-675-8621
Mailing Address - Fax:254-675-2254
Practice Address - Street 1:201 POSEY AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:TX
Practice Address - Zip Code:76634-1200
Practice Address - Country:US
Practice Address - Phone:254-675-8621
Practice Address - Fax:254-675-2254
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-06
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64439101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX210663508Medicaid