Provider Demographics
NPI:1093013740
Name:VESELY, JIMI ANTHONY
Entity Type:Individual
Prefix:MR
First Name:JIMI
Middle Name:ANTHONY
Last Name:VESELY
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 1:9801 CRYSTALLINE DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89506
Mailing Address - Country:US
Mailing Address - Phone:775-677-2640
Mailing Address - Fax:
Practice Address - Street 1:9801 CRYSTALLINE DR
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89506-7566
Practice Address - Country:US
Practice Address - Phone:775-677-2640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-04
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVGF-125403151101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor