Provider Demographics
NPI:1851498513
Name:NOBLEJAS, MARIA LAURALYNN (PSYD, LP)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:LAURALYNN
Last Name:NOBLEJAS
Suffix:
Gender:F
Credentials:PSYD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:LIBERAL
Mailing Address - State:KS
Mailing Address - Zip Code:67901-2743
Mailing Address - Country:US
Mailing Address - Phone:620-417-5230
Mailing Address - Fax:620-624-5227
Practice Address - Street 1:10 PLAZA DR
Practice Address - Street 2:
Practice Address - City:LIBERAL
Practice Address - State:KS
Practice Address - Zip Code:67901-2743
Practice Address - Country:US
Practice Address - Phone:620-417-5230
Practice Address - Fax:620-624-5227
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1316103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS119865Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUM
KS48341Medicare UPIN