Provider Demographics
NPI:1982996534
Name:JEAN FAJARDO ASSOCIATES LLC
Entity Type:Organization
Organization Name:JEAN FAJARDO ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:PAULA
Authorized Official - Last Name:FAJARDO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:702-343-3459
Mailing Address - Street 1:7465 W LAKE MEAD BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-1033
Mailing Address - Country:US
Mailing Address - Phone:702-343-3459
Mailing Address - Fax:702-343-3459
Practice Address - Street 1:7465 W LAKE MEAD BLVD STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-1033
Practice Address - Country:US
Practice Address - Phone:702-343-3459
Practice Address - Fax:702-343-3459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-13
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV20111195118251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health