MEDICARE: JENNIFER JO SMITH

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	103K00000X	Behavior Analyst		NV
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	00843	NV

General Provider Information

NPI Number	:	1265170724
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER JO SMITH

Provider Business Mailing Address
First Line	:	2921 N. TENAYA WAY
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-0601
Country	:	US
Telephone Number	:	702-831-8851
Fax Number	:

Provider Business Practice Location Address
First Line	:	7100 PIRATES COVE RD APT 1024
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89145-0601
Country	:	US
Telephone Number	:	702-831-8851
Fax Number	:

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

Provider Enumeration Date	:	05/24/2022
Last Update Date	:	02/27/2025

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Directions to “ JENNIFER JO SMITH ” Practice Location

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