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General NPI Number Information
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NPI Number | 1215558143
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Entity Type | Organization
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Legal Business Name | JESSICA MIX MFT, INC.
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Dates
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Enumeration Date | 05/01/2020
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Last Update Date | 06/20/2024
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Provider Practice Location Address
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Address Line | 5785 CENTENNIAL CENTER BLVD STE 240
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City | LAS VEGAS
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State | NV
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Zip | 89149-7108
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Country | US
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Telephone | 702-673-7796
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Fax | 866-611-8528
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Provider Business Mailing Address
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Address Line | 8414 FARM RD STE 180
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City | LAS VEGAS
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State | NV
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Zip | 89131-8007
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Country | US
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Telephone | 702-673-7796
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JESSICA MIX-TESMER
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Credential | MFT
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Telephone | 702-673-7796
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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