Provider Demographics
NPI:1841905403
Name:FAVILLE, JANE LOUISE (LCSW, LSCSW)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:LOUISE
Last Name:FAVILLE
Suffix:
Gender:F
Credentials:LCSW, LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11201 N WALLACE AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64157-1007
Mailing Address - Country:US
Mailing Address - Phone:816-810-4572
Mailing Address - Fax:
Practice Address - Street 1:1900 W 75TH ST STE 200
Practice Address - Street 2:
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66208-3501
Practice Address - Country:US
Practice Address - Phone:816-810-4572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-18
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20200216691041C0700X
KS053371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical