Provider Demographics
NPI:1609545235
Name:MCCRILLIS, JACLYNNE (LPC, NCC)
Entity Type:Individual
Prefix:
First Name:JACLYNNE
Middle Name:
Last Name:MCCRILLIS
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:JACLYNNE
Other - Middle Name:
Other - Last Name:PUTNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7247 CONSER ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66204-1823
Mailing Address - Country:US
Mailing Address - Phone:913-972-4278
Mailing Address - Fax:
Practice Address - Street 1:9401 INDIAN CREEK PKWY STE 520
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-2013
Practice Address - Country:US
Practice Address - Phone:913-972-4278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-08
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS03891101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional