Provider Demographics
NPI:1104148261
Name:TREVINO-MAACK, SYLVIA IVONNE (PHD, LCP, BCBA-D)
Entity type:Individual
Prefix:DR
First Name:SYLVIA
Middle Name:IVONNE
Last Name:TREVINO-MAACK
Suffix:
Gender:F
Credentials:PHD, LCP, BCBA-D
Other - Prefix:
Other - First Name:SYLVIA
Other - Middle Name:IVONNE
Other - Last Name:MAACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5814 GRAYHAWK CT
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66047-2068
Mailing Address - Country:US
Mailing Address - Phone:785-979-1088
Mailing Address - Fax:
Practice Address - Street 1:403 N 4TH ST
Practice Address - Street 2:
Practice Address - City:LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66048-1966
Practice Address - Country:US
Practice Address - Phone:913-250-5509
Practice Address - Fax:913-254-3151
Is Sole Proprietor?:No
Enumeration Date:2010-02-17
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1-13-12984103K00000X
KS0213103TC0700X
KS6911447291103TS0200X
KS1-13-12984103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool