=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992465041
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JAIME DUKE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/29/2021
-----------------------------------------------------
Last Update Date | 12/29/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5000 W 95TH ST STE 285
-----------------------------------------------------
City | PRAIRIE VILLAGE
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66207-3363
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 913-270-1481
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8631 WINCHESTER ST APT 13304
-----------------------------------------------------
City | LENEXA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66219-7108
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 913-645-3320
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LICENSED PROFESSIONAL COUNSELOR
-----------------------------------------------------
Name | JAIME DUKE
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 913-270-1481
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0850X
-----------------------------------------------------
Taxonomy Name | Adult Mental Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------