Healthcare Provider Details

I. General information

NPI: 1639959430
Provider Name (Legal Business Name): JIEYU CHEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2023
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2520 SAINT ROSE PKWY STE 310
HENDERSON NV
89074-7790
US

IV. Provider business mailing address

8158 KENTSHIRE DR
LAS VEGAS NV
89117-3940
US

V. Phone/Fax

Practice location:
  • Phone: 888-850-7329
  • Fax:
Mailing address:
  • Phone: 702-788-1261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMI4791
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberRBT3766
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: