MEDICARE: JAMIE GILLETTE LMFT

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	106H00000X	Marriage & Family Therapist	LMFT86257	CA
2	106H00000X	Marriage & Family Therapist	01424	NV

General Provider Information

NPI Number	:	1972990588
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMIE GILLETTE LMFT

Provider Business Mailing Address
First Line	:	7361 PRAIRIE FALCON RD STE 110
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-0824
Country	:	US
Telephone Number	:	702-294-0433
Fax Number	:

Provider Business Practice Location Address
First Line	:	7361 PRAIRIE FALCON RD STE 110
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128
Country	:	US
Telephone Number	:	702-294-0433
Fax Number	:

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

Provider Enumeration Date	:	04/21/2015
Last Update Date	:	05/08/2019

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