Provider Demographics
NPI:1346713179
Name:KAMAL, JELANI NAEEM
Entity Type:Individual
Prefix:
First Name:JELANI
Middle Name:NAEEM
Last Name:KAMAL
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 1:10764 VILLA CARLOTTA CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89141-3539
Mailing Address - Country:US
Mailing Address - Phone:702-756-9085
Mailing Address - Fax:
Practice Address - Street 1:408 S JONES BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107-2658
Practice Address - Country:US
Practice Address - Phone:702-502-8021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-04
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician