Provider Demographics
NPI:1750874731
Name:WHITFIELD, JACQUELINE REA (BA, AGS, CHT)
Entity type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:REA
Last Name:WHITFIELD
Suffix:
Gender:F
Credentials:BA, AGS, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8610 S MARYLAND PKWY APT 1014
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-2710
Mailing Address - Country:US
Mailing Address - Phone:702-556-5706
Mailing Address - Fax:
Practice Address - Street 1:8565 S EASTERN AVE STE 150
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-2906
Practice Address - Country:US
Practice Address - Phone:702-556-5706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-13
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No251B00000XAgenciesCase Management
No374K00000XNursing Service Related ProvidersReligious Nonmedical Practitioner