Provider Demographics
NPI:1962411371
Name:MASON-EISENHAUER, JODI LYN (LCP)
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:LYN
Last Name:MASON-EISENHAUER
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 1:6405 METCALF AVE
Mailing Address - Street 2:SUITE 322
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66202-3927
Mailing Address - Country:US
Mailing Address - Phone:913-961-3486
Mailing Address - Fax:
Practice Address - Street 1:6405 METCALF AVE
Practice Address - Street 2:SUITE 322
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66202-3927
Practice Address - Country:US
Practice Address - Phone:913-961-3486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS033103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist