MEDICARE: JESSICA LAUREN HOLDING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1083023758
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA LAUREN HOLDING

Provider Business Mailing Address
First Line	:	10925 SOUTHERN HIGHLANDS PKWY APT 2067
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89141-4317
Country	:	US
Telephone Number	:	702-416-7030
Fax Number	:

Provider Business Practice Location Address
First Line	:	10925 SOUTHERN HIGHLANDS PKWY APT 2067
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89141-4317
Country	:	US
Telephone Number	:	702-416-7030
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/07/2014
Last Update Date	:	02/23/2021

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Directions to “ JESSICA LAUREN HOLDING ” Practice Location

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