Provider Demographics
NPI:1952681272
Name:BAINES, JESSIE KEITH JR
Entity Type:Individual
Prefix:
First Name:JESSIE
Middle Name:KEITH
Last Name:BAINES
Suffix:JR
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 1:1810 E SAHARA AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104-3735
Mailing Address - Country:US
Mailing Address - Phone:702-207-6782
Mailing Address - Fax:702-207-6791
Practice Address - Street 1:1810 E SAHARA AVE STE 200
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-3735
Practice Address - Country:US
Practice Address - Phone:702-207-6782
Practice Address - Fax:702-207-6791
Is Sole Proprietor?:No
Enumeration Date:2011-08-17
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst