Provider Demographics
NPI:1356620488
Name:LAMASCUS, JERRY
Entity type:Individual
Prefix:
First Name:JERRY
Middle Name:
Last Name:LAMASCUS
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 1:2441 TECH CENTER CT
Mailing Address - Street 2:STE 108
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-0804
Mailing Address - Country:US
Mailing Address - Phone:702-629-6351
Mailing Address - Fax:702-629-6367
Practice Address - Street 1:7320 SMOKE RANCH RD STE H
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0259
Practice Address - Country:US
Practice Address - Phone:702-380-0600
Practice Address - Fax:702-658-1039
Is Sole Proprietor?:No
Enumeration Date:2011-08-07
Last Update Date:2018-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst