Healthcare Provider Details

I. General information

NPI: 1760009773
Provider Name (Legal Business Name): JPRM GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2020
Last Update Date: 07/20/2020
Certification Date: 07/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3925 N MARTIN L KING BLVD STE 113
N LAS VEGAS NV
89032-7674
US

IV. Provider business mailing address

3925 N MARTIN L KING BLVD STE 113
N LAS VEGAS NV
89032-7674
US

V. Phone/Fax

Practice location:
  • Phone: 702-899-0988
  • Fax: 702-442-3813
Mailing address:
  • Phone: 702-899-0988
  • Fax: 702-442-3813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ROSALIE MAYER
Title or Position: EXECUTIVE OFFICER
Credential: BS
Phone: 702-899-0988