Healthcare Provider Details

I. General information

NPI: 1407256290
Provider Name (Legal Business Name): JORDAN MAYFIELD LSCSW LCAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2014
Last Update Date: 06/06/2022
Certification Date: 06/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3320 PETERSON RD FAMILY PSYCHOLOGICAL SERVICE LLC SUITE 104
LAWRENCE KS
66049
US

IV. Provider business mailing address

3320 PETERSON RD FAMILY PSYCHOLOGICAL SERVICE LLC SUITE 104
LAWRENCE KS
66049
US

V. Phone/Fax

Practice location:
  • Phone: 785-371-1414
  • Fax: 785-371-4519
Mailing address:
  • Phone: 785-371-1414
  • Fax: 785-371-4519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number835
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number8426
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: