Provider Demographics
NPI:1275824229
Name:EISBERG, JASON (LMFT)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:
Last Name:EISBERG
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12301 W 106TH ST # 150
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66215-2283
Mailing Address - Country:US
Mailing Address - Phone:913-499-8100
Mailing Address - Fax:
Practice Address - Street 1:12301 W 106TH ST # 150
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66215-2283
Practice Address - Country:US
Practice Address - Phone:913-499-8100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-26
Last Update Date:2012-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1224106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist