Provider Demographics
NPI:1164297362
Name:JARA, JAYDEN
Entity Type:Individual
Prefix:
First Name:JAYDEN
Middle Name:
Last Name:JARA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 HILLRISE CIR
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-4759
Mailing Address - Country:US
Mailing Address - Phone:575-288-1881
Mailing Address - Fax:575-288-1889
Practice Address - Street 1:2000 WEST 21ST STREET
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101-4087
Practice Address - Country:US
Practice Address - Phone:575-288-1881
Practice Address - Fax:575-288-1889
Is Sole Proprietor?:No
Enumeration Date:2023-11-17
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician