Provider Demographics
NPI:1174214134
Name:MAYFIELD-MILLER, BIANCA
Entity type:Individual
Prefix:
First Name:BIANCA
Middle Name:
Last Name:MAYFIELD-MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3708 NW 61ST ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64151-2816
Mailing Address - Country:US
Mailing Address - Phone:816-876-6464
Mailing Address - Fax:
Practice Address - Street 1:3708 NW 61ST ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64151-2816
Practice Address - Country:US
Practice Address - Phone:816-876-6464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014002623101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional