Healthcare Provider Details

I. General information

NPI: 1104148261
Provider Name (Legal Business Name): SYLVIA IVONNE TREVINO-MAACK PHD, LCP, BCBA-D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SYLVIA IVONNE MAACK

II. Dates (important events)

Enumeration Date: 02/17/2010
Last Update Date: 07/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 N 4TH ST
LEAVENWORTH KS
66048-1966
US

IV. Provider business mailing address

5814 GRAYHAWK CT
LAWRENCE KS
66047-2068
US

V. Phone/Fax

Practice location:
  • Phone: 913-250-5509
  • Fax: 913-254-3151
Mailing address:
  • Phone: 785-979-1088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0213
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number6911447291
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-13-12984
License Number StateMO
# 4
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-13-12984
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: