Provider Demographics
NPI:1215154307
Name:MAULDIN, JOLENA KAY (LCP)
Entity type:Individual
Prefix:
First Name:JOLENA
Middle Name:KAY
Last Name:MAULDIN
Suffix:
Gender:F
Credentials:LCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 N MUR LEN RD
Mailing Address - Street 2:STE 101
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-1794
Mailing Address - Country:US
Mailing Address - Phone:913-710-9382
Mailing Address - Fax:610-643-8266
Practice Address - Street 1:801 N MUR LEN RD
Practice Address - Street 2:SUITE 101
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-1794
Practice Address - Country:US
Practice Address - Phone:713-710-9382
Practice Address - Fax:610-643-8266
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS195103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100098010BMedicaid