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General NPI Number Information
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NPI Number | 1174827489
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Entity Type | Individual
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Provider Name | JEFFREY JANES LCSW
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Gender | Male
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Dates
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Enumeration Date | 12/29/2010
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Last Update Date | 01/03/2025
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Provider Practice Location Address
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Address Line | 465 S MAIN ST
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City | FREDONIA
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State | AZ
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Zip | 86022-0200
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Country | US
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Telephone | 702-701-3806
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1987
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City | PAGE
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State | AZ
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Zip | 86040-1987
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Country | US
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Telephone | 702-701-3806
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 19575
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 1078813-3501
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License Number State | UT
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