Provider Demographics
NPI:1619480373
Name:JD BEHAVIORAL SERVICES, LLC
Entity Type:Organization
Organization Name:JD BEHAVIORAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:DEVEREAUX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-267-8124
Mailing Address - Street 1:7390 W SAHARA AVE STE 270
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-2765
Mailing Address - Country:US
Mailing Address - Phone:760-267-8124
Mailing Address - Fax:
Practice Address - Street 1:7390 W SAHARA AVE STE 270
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-2765
Practice Address - Country:US
Practice Address - Phone:760-267-8124
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-15
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20171272163251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health