Provider Demographics
NPI:1952650251
Name:MCCAULEY MAYFIELD, CHARLENE (LPC)
Entity Type:Individual
Prefix:MS
First Name:CHARLENE
Middle Name:
Last Name:MCCAULEY MAYFIELD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:CHARLENE
Other - Middle Name:MCCAULEY
Other - Last Name:MAYFIELD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:514 E COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75766-4910
Mailing Address - Country:US
Mailing Address - Phone:903-284-1974
Mailing Address - Fax:
Practice Address - Street 1:514 E COMMERCE ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:TX
Practice Address - Zip Code:75766-4910
Practice Address - Country:US
Practice Address - Phone:903-372-1767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-31
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional