Provider Demographics
NPI:1609068634
Name:ROBERTS, JAYDE (CADC INTERN)
Entity Type:Individual
Prefix:MS
First Name:JAYDE
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:CADC INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 W CHARLESTON BLVD
Mailing Address - Street 2:SUITE #300
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-2325
Mailing Address - Country:US
Mailing Address - Phone:702-251-8000
Mailing Address - Fax:702-366-0269
Practice Address - Street 1:1701 W CHARLESTON BLVD
Practice Address - Street 2:SUITE #300
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-2325
Practice Address - Country:US
Practice Address - Phone:702-251-8000
Practice Address - Fax:702-366-0269
Is Sole Proprietor?:No
Enumeration Date:2007-08-14
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV00413-I101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)