Provider Demographics
NPI:1265657084
Name:JAIRAJ, MARIA LISA (MS LPC)
Entity Type:Individual
Prefix:MS
First Name:MARIA
Middle Name:LISA
Last Name:JAIRAJ
Suffix:
Gender:F
Credentials:MS LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1416 GLENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:AZLE
Mailing Address - State:TX
Mailing Address - Zip Code:76020-5139
Mailing Address - Country:US
Mailing Address - Phone:469-328-1980
Mailing Address - Fax:817-270-0105
Practice Address - Street 1:504 BUSINESS PKWY
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-5013
Practice Address - Country:US
Practice Address - Phone:469-328-1980
Practice Address - Fax:817-270-0105
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18683101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional