Provider Demographics
NPI:1326619834
Name:HART, JAIME LYN (LCPC)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:LYN
Last Name:HART
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:JAIME
Other - Middle Name:LYN
Other - Last Name:DEAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:664 S LIGHTNER DR
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67218-2734
Mailing Address - Country:US
Mailing Address - Phone:224-651-7757
Mailing Address - Fax:
Practice Address - Street 1:2909 W 13TH ST N
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-6618
Practice Address - Country:US
Practice Address - Phone:316-613-1597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-06
Last Update Date:2023-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6166101YP2500X
KS03368101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty