Provider Demographics
NPI:1386191542
Name:STANSBURY, JENNAFER LAUREN (BA PSYCHOLOGY)
Entity Type:Individual
Prefix:
First Name:JENNAFER
Middle Name:LAUREN
Last Name:STANSBURY
Suffix:
Gender:F
Credentials:BA PSYCHOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1421 N JONES BLVD
Mailing Address - Street 2:#198
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89108-0140
Mailing Address - Country:US
Mailing Address - Phone:702-350-9749
Mailing Address - Fax:702-758-5364
Practice Address - Street 1:1421 N JONES BLVD
Practice Address - Street 2:#198
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89108-1610
Practice Address - Country:US
Practice Address - Phone:702-350-9749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-06
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor