MEDICARE: MS. ALVA REENE JEFFRIES M.A.

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	101YS0200X	School Counselor	3785087	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	690976/1043419641	OTHER	AZ	AHCCCS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770899296
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ALVA REENE JEFFRIES M.A.

Provider Business Mailing Address
First Line	:	3623 W MORROW DR
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85308-2323
Country	:	US
Telephone Number	:	310-487-2639
Fax Number	:

Provider Business Practice Location Address
First Line	:	19871 W FREEMONT RD
Second Line	:
City	:	BUCKEYE
State	:	AZ
Zip	:	85326-9512
Country	:	US
Telephone Number	:	623-474-6671
Fax Number	:

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

Provider Enumeration Date	:	08/21/2010
Last Update Date	:	08/21/2010

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