Provider Demographics
NPI:1265214332
Name:JEEVANBA, SATHYA BAANU (PHD)
Entity type:Individual
Prefix:DR
First Name:SATHYA
Middle Name:BAANU
Last Name:JEEVANBA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:731 E 62ND ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64110-3381
Mailing Address - Country:US
Mailing Address - Phone:816-905-8936
Mailing Address - Fax:
Practice Address - Street 1:731 E 62ND ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64110-3381
Practice Address - Country:US
Practice Address - Phone:816-905-8936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022046957103TC1900X
KS03161103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling