Provider Demographics
NPI:1235496852
Name:BURRIES, JAZELLE
Entity Type:Individual
Prefix:
First Name:JAZELLE
Middle Name:
Last Name:BURRIES
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 1:2820 E LAKE MEAD BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89030-6514
Mailing Address - Country:US
Mailing Address - Phone:702-265-7651
Mailing Address - Fax:702-685-7408
Practice Address - Street 1:2820 E LAKE MEAD BLVD
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030-6514
Practice Address - Country:US
Practice Address - Phone:702-265-7651
Practice Address - Fax:702-685-7408
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-19
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst