Provider Demographics
NPI:1700644291
Name:MAYBERRY, JOLEESA (LPC)
Entity Type:Individual
Prefix:
First Name:JOLEESA
Middle Name:
Last Name:MAYBERRY
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 1:15713 VALLEYVIEW DR
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66223-3363
Mailing Address - Country:US
Mailing Address - Phone:913-279-0431
Mailing Address - Fax:
Practice Address - Street 1:15713 VALLEYVIEW DR
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66223-3363
Practice Address - Country:US
Practice Address - Phone:913-258-0732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-08
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLPC04002101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional