Provider Demographics
NPI:1003208810
Name:VINOCUR, JASON
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:VINOCUR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 14TH ST
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-6302
Mailing Address - Country:US
Mailing Address - Phone:214-650-6708
Mailing Address - Fax:
Practice Address - Street 1:6200 VIRGINIA PKWY
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-5504
Practice Address - Country:US
Practice Address - Phone:214-650-6708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-03
Last Update Date:2018-12-03
Deactivation Date:2018-10-09
Deactivation Code:
Reactivation Date:2018-12-03
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst