Provider Demographics
NPI:1679184907
Name:JIMERSON, SHAKARIYAH L
Entity Type:Individual
Prefix:
First Name:SHAKARIYAH
Middle Name:L
Last Name:JIMERSON
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 1:3606 N RANCHO DR STE 102
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89130-3196
Mailing Address - Country:US
Mailing Address - Phone:702-800-1926
Mailing Address - Fax:
Practice Address - Street 1:3606 N RANCHO DR STE 102
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-3196
Practice Address - Country:US
Practice Address - Phone:702-800-1926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor