Healthcare Provider Details

I. General information

NPI: 1750124038
Provider Name (Legal Business Name): JENNIFER MAHURIN LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNI MAHURIN

II. Dates (important events)

Enumeration Date: 06/14/2024
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6001 NIEMAN RD STE 205
SHAWNEE KS
66203-2937
US

IV. Provider business mailing address

5019 NE 37TH ST
KANSAS CITY MO
64117-2726
US

V. Phone/Fax

Practice location:
  • Phone: 913-430-9506
  • Fax:
Mailing address:
  • Phone: 913-430-9506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number13647
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: