MEDICARE: MS. JASONIA CLARNETTA MARTIN

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	101YM0800X	Mental Health Counselor		NV
2	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1316295520
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JASONIA CLARNETTA MARTIN

Provider Business Mailing Address
First Line	:	4513 SWITCHBACK ST
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-4340
Country	:	US
Telephone Number	:	702-601-8208
Fax Number	:

Provider Business Practice Location Address
First Line	:	4513 SWITCHBACK ST
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-4340
Country	:	US
Telephone Number	:	702-601-8208
Fax Number	:

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

Provider Enumeration Date	:	08/20/2012
Last Update Date	:	08/21/2012

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