MEDICARE: MAYFIELD COUNSELING CENTERS

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	101YM0800X	Mental Health Counselor	11420	CO

General Provider Information

NPI Number	:	1588166144
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAYFIELD COUNSELING CENTERS

Provider Business Mailing Address
First Line	:	1283 KELLY JOHNSON BLVD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-3925
Country	:	US
Telephone Number	:	719-452-4803
Fax Number	:

Provider Business Practice Location Address
First Line	:	1283 KELLY JOHNSON BLVD STE 100
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-3925
Country	:	US
Telephone Number	:	719-452-4801
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	DR. KARLA KAY YATES
Credential	:	LCSW
Telephone Number	:	719-452-4803

Provider Enumeration Date	:	02/28/2018
Last Update Date	:	07/05/2023

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