Individual
MARK D MANSFIELD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MC, LAC
Contact information
Practice address
15820 N 35TH AVE STE 14, PHOENIX, AZ 85053-7608
(602) 859-9169
Mailing address
5139 E TANO ST, PHOENIX, AZ 85044-4120
(480) 241-8119
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LPC-20544
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LPC-20544
AZ BOARD OF BEHAVIORAL HEALTH
AZ
Enumeration date
11/12/2018
Last updated
10/13/2022
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