=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447500848
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHAMIKA LEONA JONES L.S.W
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/12/2012
-----------------------------------------------------
Last Update Date | 09/12/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 522 E LAKE MEAD PKWY
-----------------------------------------------------
City | HENDERSON
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89015-5530
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-486-2252
-----------------------------------------------------
Fax | 702-455-7961
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 608 BRUNY ISLAND AVE
-----------------------------------------------------
City | NORTH LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89081-2303
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 6301-S
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------