Provider Demographics
NPI:1356899827
Name:MAITLAND, KAYDENE A (LPC)
Entity type:Individual
Prefix:
First Name:KAYDENE
Middle Name:A
Last Name:MAITLAND
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 1:3043 N CAMINO LAGOS
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75054-6797
Mailing Address - Country:US
Mailing Address - Phone:954-296-1383
Mailing Address - Fax:
Practice Address - Street 1:1425 GREENWAY DR # 360
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038-2447
Practice Address - Country:US
Practice Address - Phone:972-421-8130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-14
Last Update Date:2025-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX68010101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional