Provider Demographics
NPI:1811332489
Name:ANDERSON, JAMEISHA DENISE
Entity type:Individual
Prefix:
First Name:JAMEISHA
Middle Name:DENISE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5271 PARADISE VALLEY AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89156-5648
Mailing Address - Country:US
Mailing Address - Phone:702-502-1448
Mailing Address - Fax:
Practice Address - Street 1:1200 HELEN AVE
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030-3721
Practice Address - Country:US
Practice Address - Phone:702-636-9229
Practice Address - Fax:702-636-9229
Is Sole Proprietor?:No
Enumeration Date:2013-05-08
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4612913454103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV103K00000XMedicaid