Doctor Name: | PHYLISS MAYFIELD |
NPI Number: | 1386922045 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPC |
License Number: | 1986 |
Business Practice Address: | 220 4th Ave Raton, NM - 877402643 |
Business Phone Number: | 5754452754 |
Business Fax Number: | |
Mailing Address: | 413 Sipapu St, TAOS |
State: | NM |
Postal Code: | 875716489 |
Phone Number: | 5757585857 |
Fax Number: | |
NPI Enumeration Date: | 07/29/2011 |
NPI Last Update Date: | 07/29/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 1986 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NM |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |