MEDICARE: JPRM GROUP LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	103TP2701X	Group Psychotherapy Psychologist
3	1041C0700X	Clinical Social Worker
4	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1760009773
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JPRM GROUP LLC

Provider Business Mailing Address
First Line	:	3925 N MARTIN L KING BLVD STE 113
Second Line	:
City	:	N LAS VEGAS
State	:	NV
Zip	:	89032-7674
Country	:	US
Telephone Number	:	702-899-0988
Fax Number	:	702-442-3813

Provider Business Practice Location Address
First Line	:	3925 N MARTIN L KING BLVD STE 113
Second Line	:
City	:	N LAS VEGAS
State	:	NV
Zip	:	89032-7674
Country	:	US
Telephone Number	:	702-899-0988
Fax Number	:	702-442-3813

Authorized Official
Title or Position	:	EXECUTIVE OFFICER
Name	:	ROSALIE MAYER
Credential	:	BS
Telephone Number	:	702-899-0988

Provider Enumeration Date	:	06/26/2020
Last Update Date	:	07/20/2020

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