Provider Demographics
NPI:1366738429
Name:MAYFIELD, RACHEL R (MA LPC)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:R
Last Name:MAYFIELD
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1508 W KAY ST
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MO
Mailing Address - Zip Code:65340-2957
Mailing Address - Country:US
Mailing Address - Phone:660-202-9889
Mailing Address - Fax:
Practice Address - Street 1:500 E COLLEGE ST
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MO
Practice Address - Zip Code:65340-3109
Practice Address - Country:US
Practice Address - Phone:660-831-4139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-27
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010021270101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional