Healthcare Provider Details

I. General information

NPI: 1144231689
Provider Name (Legal Business Name): JAMI DEL PEGG LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JAMI DEL LONGWITH LONGWITH

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 06/07/2024
Certification Date: 06/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2810 LOCHBROOM WAY
HENDERSON NV
89044-8765
US

IV. Provider business mailing address

2810 LOCHBROOM WAY
HENDERSON NV
89044-8765
US

V. Phone/Fax

Practice location:
  • Phone: 816-304-4967
  • Fax:
Mailing address:
  • Phone: 816-304-4967
  • Fax: 816-373-3939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number784
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2001001598
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCP1212R
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: