Provider Demographics
NPI:1073997896
Name:BROWNRIDGE, JAQUON QUATERIAL
Entity Type:Individual
Prefix:
First Name:JAQUON
Middle Name:QUATERIAL
Last Name:BROWNRIDGE
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 1:8637 PALOMINO RANCH ST
Mailing Address - Street 2:8637
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89131-5245
Mailing Address - Country:US
Mailing Address - Phone:919-802-1696
Mailing Address - Fax:
Practice Address - Street 1:8637 PALOMINO RANCH ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89131-5245
Practice Address - Country:US
Practice Address - Phone:919-802-1696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-10
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor