MEDICARE: MS. LOREN YECENIA MAYFIELD NO CREDENTIALS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor

General Provider Information

NPI Number	:	1912264417
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LOREN YECENIA MAYFIELD NO CREDENTIALS

Provider Business Mailing Address
First Line	:	2039 NE 27TH ST
Second Line	:	N/A
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73111-3412
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2039 NORTH EAST 27TH STREET
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73111-3412
Country	:	US
Telephone Number	:	405-889-8576
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2012
Last Update Date	:	04/20/2012

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