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NPI Code Detail

MEDICARE: JENNIFER DOUGLAS MS, CPC-INTERN

MEDICARE: JENNIFER DOUGLAS MS, CPC-INTERN
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
1101YM0800XMental Health CounselorCI5471NV

General Provider Information

NPI Number : 1699596577
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER DOUGLAS MS, CPC-INTERN
Provider Business Mailing Address
First Line : 3053 W CRAIG RD STE E320
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89032-5124
Country : US
Telephone Number : 702-301-1925
Fax Number :
Provider Business Practice Location Address
First Line : 7433 EGGSHELL DR
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89084-2481
Country : US
Telephone Number : 702-530-5007
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/23/2024
Last Update Date : 10/23/2024

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