1023671302 NPI number — JASMINE SAROYA MYERS PSYD, MS, MA

Table of content: JASMINE SAROYA MYERS PSYD, MS, MA (NPI 1023671302)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023671302 NPI number — JASMINE SAROYA MYERS PSYD, MS, MA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MYERS
Provider First Name:
JASMINE
Provider Middle Name:
SAROYA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PSYD, MS, MA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
THOMPSON
Provider Other First Name:
JASMINE
Provider Other Middle Name:
SAROYA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PSYD, MA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1023671302
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/22/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4528 W CRAIG RD STE 110
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89032-2505
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-647-6433
Provider Business Mailing Address Fax Number:
702-647-6434

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3560 SOUTH POINTE CIRCLE SUITE 109
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAUGHLIN
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89029
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-647-6433
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/22/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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