MEDICARE: BRIANNA JAFFE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1225742653
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIANNA JAFFE

Provider Business Mailing Address
First Line	:	12440 SKY BLUFF CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89138-6246
Country	:	US
Telephone Number	:	702-306-4750
Fax Number	:

Provider Business Practice Location Address
First Line	:	5524 S FORT APACHE RD STE 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-7669
Country	:	US
Telephone Number	:	702-478-4046
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/10/2023
Last Update Date	:	01/10/2023

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