Healthcare Provider Details

I. General information

NPI: 1063502904
Provider Name (Legal Business Name): STEVEN B. MAYHEW PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 12/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E. CENTENNIAL DR. SUITE 13
PITTSBURG KS
66762
US

IV. Provider business mailing address

105 W. 7TH. STREET SUITE 100-A
PITTSBURG KS
66762
US

V. Phone/Fax

Practice location:
  • Phone: 620-231-1068
  • Fax: 620-231-2792
Mailing address:
  • Phone: 620-231-7600
  • Fax: 620-231-7602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1276
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: