Basic Information
| Provider Information | |||||||||
| NPI: | 1366983694 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DEINES | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | |||||||||
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| Credential: | PSYD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1832 | ||||||||
| Address2: | |||||||||
| City: | PITTSBURG | ||||||||
| State: | KS | ||||||||
| PostalCode: | 667621832 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6202311960 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2051 N STATE ST | ||||||||
| Address2: | |||||||||
| City: | IOLA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 667491677 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6203806600 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2017 | ||||||||
| LastUpdateDate: | 12/23/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 2017005257 | MO | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 103TB0200X | 2017037305 | MO | N | Behavioral Health & Social Service Providers | Psychologist | Cognitive & Behavioral | 103TC0700X | 02938 | KS | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.