Provider Demographics
NPI:1356767263
Name:ROTHFORD, JANISSE BROOKE (MS)
Entity type:Individual
Prefix:
First Name:JANISSE
Middle Name:BROOKE
Last Name:ROTHFORD
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2129 ELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89086-1568
Mailing Address - Country:US
Mailing Address - Phone:559-284-9614
Mailing Address - Fax:
Practice Address - Street 1:6600 RANGE RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89165-1805
Practice Address - Country:US
Practice Address - Phone:702-831-1054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-16
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCP3331-R101YM0800X
CALPCC3866101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health