Provider Demographics
NPI:1174827489
Name:JANES, JEFFREY (LCSW)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:JANES
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1987
Mailing Address - Street 2:
Mailing Address - City:PAGE
Mailing Address - State:AZ
Mailing Address - Zip Code:86040-1987
Mailing Address - Country:US
Mailing Address - Phone:702-701-3806
Mailing Address - Fax:
Practice Address - Street 1:465 S MAIN ST
Practice Address - Street 2:
Practice Address - City:FREDONIA
Practice Address - State:AZ
Practice Address - Zip Code:86022-0200
Practice Address - Country:US
Practice Address - Phone:702-701-3806
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-29
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ195751041C0700X
UT1078813-35011041C0700X
225400000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner