Basic Information
| Provider Information | |||||||||
| NPI: | 1003140781 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MAHER JURADO | ||||||||
| FirstName: | FAYE | ||||||||
| MiddleName: | CLARE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | L.P.C. & L.M.A.C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12311 W 79TH TER | ||||||||
| Address2: | |||||||||
| City: | LENEXA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662152603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9132038939 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6331 W 110TH ST | ||||||||
| Address2: | |||||||||
| City: | OVERLAND PARK | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662111509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9136961911 | ||||||||
| FaxNumber: | 9136961619 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2009 | ||||||||
| LastUpdateDate: | 01/06/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 697 | KS | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YP2500X | 2139 | KS | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
| ID | Type | State | Issuer | Description | 101YA0400X | 05 | KS | MEDICAID |