Provider Demographics
NPI:1659885671
Name:JARLDANE, MAURA CARMODY (MED, LPC-S, NCC)
Entity Type:Individual
Prefix:
First Name:MAURA
Middle Name:CARMODY
Last Name:JARLDANE
Suffix:
Gender:F
Credentials:MED, LPC-S, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4711 NEELY AVE
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79707-5215
Mailing Address - Country:US
Mailing Address - Phone:432-894-0963
Mailing Address - Fax:
Practice Address - Street 1:1700 N BIG SPRING ST
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-2624
Practice Address - Country:US
Practice Address - Phone:432-682-7273
Practice Address - Fax:432-685-0108
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-29
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63404101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional