Provider Demographics
NPI:1255629317
Name:JEFFERY D JANNEY LLC
Entity type:Organization
Organization Name:JEFFERY D JANNEY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW
Authorized Official - Prefix:
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:JANNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-379-1936
Mailing Address - Street 1:113 BLUE JAY DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LIBERTY
Mailing Address - State:MO
Mailing Address - Zip Code:64068-1918
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:113 BLUE JAY DR
Practice Address - Street 2:SUITE 101
Practice Address - City:LIBERTY
Practice Address - State:MO
Practice Address - Zip Code:64068-1918
Practice Address - Country:US
Practice Address - Phone:816-379-1936
Practice Address - Fax:816-479-2903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-11
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004032415251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health