Healthcare Provider Details

I. General information

NPI: 1316388127
Provider Name (Legal Business Name): JESSICA LEE HASS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2013
Last Update Date: 08/12/2022
Certification Date: 08/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1607 E WINDMILL LN STE 300
LAS VEGAS NV
89123-1910
US

IV. Provider business mailing address

1607 E WINDMILL LN STE 300
LAS VEGAS NV
89123-1910
US

V. Phone/Fax

Practice location:
  • Phone: 27-578-7207
  • Fax: 702-974-4677
Mailing address:
  • Phone: 702-757-8720
  • Fax: 702-974-4677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number7374-C
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: