Provider Demographics
NPI:1265714687
Name:MAYFIELD, MARK AARON (MA, NCC)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:AARON
Last Name:MAYFIELD
Suffix:
Gender:M
Credentials:MA, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6180 LEHMAN DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-3444
Mailing Address - Country:US
Mailing Address - Phone:719-439-8014
Mailing Address - Fax:
Practice Address - Street 1:6180 LEHMAN DR
Practice Address - Street 2:SUITE 100
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-3444
Practice Address - Country:US
Practice Address - Phone:719-439-8014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-12
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.OD1420101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional