Healthcare Provider Details

I. General information

NPI: 1972466621
Provider Name (Legal Business Name): JANELLE THOMPSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3430 E RUSSELL RD STE AND315
LAS VEGAS NV
89120-2201
US

IV. Provider business mailing address

3430 E RUSSELL RD STE AND315
LAS VEGAS NV
89120-2201
US

V. Phone/Fax

Practice location:
  • Phone: 725-238-6990
  • Fax: 207-510-0562
Mailing address:
  • Phone: 725-238-6990
  • Fax: 207-510-0562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number12611-M
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: