Basic Information
| Provider Information | |||||||||
| NPI: | 1518315050 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | REIME | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | MARY | ||||||||
| NamePrefix: | MS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2350 S JONES BLVD | ||||||||
| Address2: | SUITE 101 OFFICE 206B | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891463103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7022142147 | ||||||||
| FaxNumber: | 8886889464 | ||||||||
| Practice Location | |||||||||
| Address1: | 2350 S JONES BLVD | ||||||||
| Address2: | SUITE 101 OFFICE 206B | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891463103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7022142147 | ||||||||
| FaxNumber: | 8886889464 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2016 | ||||||||
| LastUpdateDate: | 09/30/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.