Provider Demographics
NPI:1336517721
Name:MAYFIELD, KRISPIN (LPC)
Entity type:Individual
Prefix:MR
First Name:KRISPIN
Middle Name:
Last Name:MAYFIELD
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19013 NE COUCH LN
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97230-7861
Mailing Address - Country:US
Mailing Address - Phone:971-255-3220
Mailing Address - Fax:
Practice Address - Street 1:19013 NE COUCH LN
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97230-7861
Practice Address - Country:US
Practice Address - Phone:971-255-3220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-02
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC3873101YP2500X
MN1452101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional