Provider Demographics
NPI:1598285041
Name:DANTIS, JAMIE D
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:D
Last Name:DANTIS
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 1:4443 WOODCREST RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-4922
Mailing Address - Country:US
Mailing Address - Phone:702-501-8972
Mailing Address - Fax:
Practice Address - Street 1:2881 S VALLEY VIEW BLVD STE 11
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-0173
Practice Address - Country:US
Practice Address - Phone:702-816-2777
Practice Address - Fax:702-750-2147
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-26
Last Update Date:2017-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty