Provider Demographics
NPI:1346702610
Name:MCCOOL, MAURA PRIMARY
Entity Type:Individual
Prefix:
First Name:MAURA
Middle Name:PRIMARY
Last Name:MCCOOL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6025 METCALF LN STE 100
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66202-2339
Mailing Address - Country:US
Mailing Address - Phone:913-499-8103
Mailing Address - Fax:816-817-6338
Practice Address - Street 1:6025 METCALF LN STE 100
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:KS
Practice Address - Zip Code:66202-2339
Practice Address - Country:US
Practice Address - Phone:913-499-8103
Practice Address - Fax:816-817-6338
Is Sole Proprietor?:No
Enumeration Date:2019-04-04
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2910101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional