Provider Demographics
NPI:1376032383
Name:NELSON, JARED DAUNE
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:DAUNE
Last Name:NELSON
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 1:7455 ARROYO CROSSING PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-4086
Mailing Address - Country:US
Mailing Address - Phone:702-761-6468
Mailing Address - Fax:702-761-6401
Practice Address - Street 1:7455 ARROYO CROSSING PKWY STE 220
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-4088
Practice Address - Country:US
Practice Address - Phone:702-761-6468
Practice Address - Fax:702-761-6401
Is Sole Proprietor?:No
Enumeration Date:2018-05-04
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health