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General NPI Number Information
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NPI Number | 1104148261
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Entity Type | Individual
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Provider Name | SYLVIA IVONNE TREVINO-MAACK PHD, LCP, BCBA-D
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Gender | Female
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Dates
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Enumeration Date | 02/17/2010
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Last Update Date | 07/02/2019
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Provider Practice Location Address
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Address Line | 403 N 4TH ST
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City | LEAVENWORTH
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State | KS
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Zip | 66048-1966
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Country | US
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Telephone | 913-250-5509
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Fax | 913-254-3151
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Provider Business Mailing Address
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Address Line | 5814 GRAYHAWK CT
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City | LAWRENCE
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State | KS
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Zip | 66047-2068
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Country | US
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Telephone | 785-979-1088
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-13-12984
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 0213
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License Number State | KS
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Taxonomy #3
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | 6911447291
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License Number State | KS
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Taxonomy #4
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-13-12984
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License Number State | KS
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