Provider Demographics
NPI:1720296023
Name:MAYFIELD, FRED L II (THERAPIST)
Entity Type:Individual
Prefix:DR
First Name:FRED
Middle Name:L
Last Name:MAYFIELD
Suffix:II
Gender:M
Credentials:THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10965 GRANADA LN
Mailing Address - Street 2:SUITE 103
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1401
Mailing Address - Country:US
Mailing Address - Phone:913-491-4788
Mailing Address - Fax:
Practice Address - Street 1:10965 GRANADA LN
Practice Address - Street 2:SUITE 103
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211-1401
Practice Address - Country:US
Practice Address - Phone:913-491-4788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS97106H00000X
KS114101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist