Provider Demographics
NPI:1487100517
Name:MAYFIELD, JOAN (PHD)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:MAYFIELD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9735 WINDHAM DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-2320
Mailing Address - Country:US
Mailing Address - Phone:214-570-9737
Mailing Address - Fax:
Practice Address - Street 1:9735 WINDHAM DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-2320
Practice Address - Country:US
Practice Address - Phone:214-570-9737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-29
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX26888103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist