Provider Demographics
NPI:1104574854
Name:HAIEM, JACLYN (MED & CPC-I)
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:
Last Name:HAIEM
Suffix:
Gender:F
Credentials:MED & CPC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11717 VIA ESPERANZA AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89138-6023
Mailing Address - Country:US
Mailing Address - Phone:484-358-5387
Mailing Address - Fax:
Practice Address - Street 1:3890 W ANN RD
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-4416
Practice Address - Country:US
Practice Address - Phone:702-287-8895
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-11
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health