Provider Demographics
NPI:1013554179
Name:HERNANDEZ, MAUREEN NICOLE (LPC)
Entity Type:Individual
Prefix:
First Name:MAUREEN NICOLE
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13710 BARBER AVENUE
Mailing Address - Street 2:
Mailing Address - City:BONNER SPRINGS
Mailing Address - State:KS
Mailing Address - Zip Code:66012-1712
Mailing Address - Country:US
Mailing Address - Phone:913-721-7177
Mailing Address - Fax:913-745-6654
Practice Address - Street 1:201 E LOULA ST STE 212
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-3459
Practice Address - Country:US
Practice Address - Phone:913-721-7177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-06
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS3284101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional