Healthcare Provider Details

I. General information

NPI: 1881521698
Provider Name (Legal Business Name): MAELA STEVENS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

524 N MAIN ST
EL DORADO KS
67042-2024
US

IV. Provider business mailing address

430 N WALNUT ST
AUGUSTA KS
67010-1036
US

V. Phone/Fax

Practice location:
  • Phone: 316-321-6036
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number03482-T
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: