1154447290 NPI number — JENIS ASSOCIATES, LLC

Table of content: (NPI 1154447290)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154447290 NPI number — JENIS ASSOCIATES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JENIS ASSOCIATES, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
RIBBONS OF LIFE COUNSELING
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154447290
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/17/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4111 E VALLEY AUTO DR
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
MESA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85206-4605
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-775-3528
Provider Business Mailing Address Fax Number:
480-813-2987

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4111 E VALLEY AUTO DR
Provider Second Line Business Practice Location Address:
SUITE 201D
Provider Business Practice Location Address City Name:
MESA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85206-4605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-775-3528
Provider Business Practice Location Address Fax Number:
480-813-2987
Provider Enumeration Date:
03/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BEATTY-TAYLOR
Authorized Official First Name:
DAWN
Authorized Official Middle Name:
RENEE
Authorized Official Title or Position:
LICENSED PROFESSIONAL COUNSELOR
Authorized Official Telephone Number:
480-775-3528

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  LPC-10886 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 896467 . This is a "AHCCCS PROVIDER ID" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 7434358 . This is a "AETNA PROVIDER ID" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 760718268 . This is a "MAGELLAN PROVIDER ID" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 760718268 . This is a "AFMC PROVIDER ID" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com