Healthcare Provider Details

I. General information

NPI: 1851220701
Provider Name (Legal Business Name): JARED DANIEL SELTZER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2451 S BUFFALO DR STE 120
LAS VEGAS NV
89117-2749
US

IV. Provider business mailing address

2451 S BUFFALO DR STE 120
LAS VEGAS NV
89117-2749
US

V. Phone/Fax

Practice location:
  • Phone: 702-546-9600
  • Fax: 702-829-8065
Mailing address:
  • Phone: 702-546-9600
  • Fax: 702-829-8065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY1308
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: