Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist | NV |
NPI | 1467862755 |
---|---|
Provider Name | Mr. Lemonte Jefferson |
First Address | Las Vegas, NV 89107-1103 |
Second Address | Las Vegas, NV 89107-1103 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2014 |
Last Update Date | 07/05/2014 |