Provider Demographics
NPI:1700681772
Name:MAYFIELD, MICHAEL JAMES JR
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JAMES
Last Name:MAYFIELD
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5415 S 20TH STREET CIR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68512-1407
Mailing Address - Country:US
Mailing Address - Phone:402-730-2338
Mailing Address - Fax:
Practice Address - Street 1:5415 S 20TH STREET CIR
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68512-1407
Practice Address - Country:US
Practice Address - Phone:402-730-2338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-14
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities