Healthcare Provider Details

I. General information

NPI: 1902545189
Provider Name (Legal Business Name): NEVADA CENTER FOR NEURODIVERSITY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2022
Last Update Date: 06/03/2022
Certification Date: 06/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3017 W CHARLESTON BLVD STE 54
LAS VEGAS NV
89102-1927
US

IV. Provider business mailing address

3017 W CHARLESTON BLVD STE 54
LAS VEGAS NV
89102-1927
US

V. Phone/Fax

Practice location:
  • Phone: 702-675-4410
  • Fax:
Mailing address:
  • Phone: 702-675-4410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. JENNIFER KAREMLY
Title or Position: PSYCHOLOGIST
Credential: PH D
Phone: 702-580-4196