Provider Demographics
NPI:1497177612
Name:JASAMES, CAMILYA RESHUNTAE
Entity Type:Individual
Prefix:
First Name:CAMILYA
Middle Name:RESHUNTAE
Last Name:JASAMES
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 1:5079 W MOBERLY AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89139-0142
Mailing Address - Country:US
Mailing Address - Phone:702-205-3683
Mailing Address - Fax:
Practice Address - Street 1:5079 W MOBERLY AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89139
Practice Address - Country:US
Practice Address - Phone:702-205-3683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-07
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1401419488101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor