Provider Demographics
NPI:1750426474
Name:ALI, JAMIL M (PSYD)
Entity type:Individual
Prefix:DR
First Name:JAMIL
Middle Name:M
Last Name:ALI
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2445 FIRE MESA ST
Mailing Address - Street 2:270
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-9014
Mailing Address - Country:US
Mailing Address - Phone:702-363-6025
Mailing Address - Fax:
Practice Address - Street 1:2445 FIRE MESA ST
Practice Address - Street 2:270
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-9014
Practice Address - Country:US
Practice Address - Phone:702-212-3008
Practice Address - Fax:702-933-3064
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPY0366103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical