Healthcare Provider Details

I. General information

NPI: 1700611803
Provider Name (Legal Business Name): JARED BERROCAL CPC
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2024
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1070 W HORIZON RIDGE PKWY STE 200
HENDERSON NV
89012-6019
US

IV. Provider business mailing address

1070 W HORIZON RIDGE PKWY STE 200
HENDERSON NV
89012-6019
US

V. Phone/Fax

Practice location:
  • Phone: 702-292-7026
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCP6408
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCP6408
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: