Provider Demographics
NPI:1891865531
Name:JANES, JEAN K (MA, MED)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:K
Last Name:JANES
Suffix:
Gender:F
Credentials:MA, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6546 E PRESIDIO ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85215-0974
Mailing Address - Country:US
Mailing Address - Phone:480-987-7400
Mailing Address - Fax:
Practice Address - Street 1:20740 S ELLSWORTH RD
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85242-9058
Practice Address - Country:US
Practice Address - Phone:480-987-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool