Provider Demographics
NPI:1710948849
Name:HASKELL, JEREMY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:
Last Name:HASKELL
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4250 GRIFFISS AVE
Mailing Address - Street 2:432D WING (ATTN: MAJ. JEREMY HASKELL)
Mailing Address - City:NELLIS AIR FORCE BASE
Mailing Address - State:NV
Mailing Address - Zip Code:89191
Mailing Address - Country:US
Mailing Address - Phone:702-404-3986
Mailing Address - Fax:
Practice Address - Street 1:4250 GRIFFISS AVE
Practice Address - Street 2:432D WING (ATTN: MAJ. JEREMY HASKELL)
Practice Address - City:NELLIS AIR FORCE BASE
Practice Address - State:NV
Practice Address - Zip Code:89191
Practice Address - Country:US
Practice Address - Phone:702-404-3986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-29
Last Update Date:2013-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist