MEDICARE: JENNAFER LAUREN STANSBURY BA PSYCHOLOGY

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	101Y00000X	Counselor		NV

General Provider Information

NPI Number	:	1386191542
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNAFER LAUREN STANSBURY BA PSYCHOLOGY

Provider Business Mailing Address
First Line	:	1421 N JONES BLVD
Second Line	:	#198
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-0140
Country	:	US
Telephone Number	:	702-350-9749
Fax Number	:	702-758-5364

Provider Business Practice Location Address
First Line	:	1421 N JONES BLVD
Second Line	:	#198
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-1610
Country	:	US
Telephone Number	:	702-350-9749
Fax Number	:

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

Provider Enumeration Date	:	09/06/2016
Last Update Date	:	09/06/2016

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