Provider Demographics
NPI:1003541533
Name:STONE, JACQUELINE THERESE (LPC)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:THERESE
Last Name:STONE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5007 OUTLOOK RD
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66202-1842
Mailing Address - Country:US
Mailing Address - Phone:612-578-4777
Mailing Address - Fax:
Practice Address - Street 1:5750 W 95TH ST STE 220
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66207-2969
Practice Address - Country:US
Practice Address - Phone:913-444-5602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-19
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04108101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor