Provider Demographics
NPI:1760740773
Name:SHOEMAKER, JARED
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:
Last Name:SHOEMAKER
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 1:84 DARK CREEK AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89183-5654
Mailing Address - Country:US
Mailing Address - Phone:702-319-1555
Mailing Address - Fax:702-876-2269
Practice Address - Street 1:84 DARK CREEK AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89183-5654
Practice Address - Country:US
Practice Address - Phone:702-319-1555
Practice Address - Fax:702-876-2269
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-26
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health