Provider Demographics
NPI:1578941134
Name:PRIMOUS, LAJUNE
Entity Type:Individual
Prefix:
First Name:LAJUNE
Middle Name:
Last Name:PRIMOUS
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 1:877 MILLER AVENUE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89036
Mailing Address - Country:US
Mailing Address - Phone:702-749-6333
Mailing Address - Fax:702-749-6334
Practice Address - Street 1:5871 WINDY POINT TRL
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89142-1667
Practice Address - Country:US
Practice Address - Phone:702-749-6333
Practice Address - Fax:702-749-6334
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-14
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst