Provider Demographics
NPI:1124632963
Name:WHITLOW, JAZMYNE MARILEE
Entity type:Individual
Prefix:
First Name:JAZMYNE
Middle Name:MARILEE
Last Name:WHITLOW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6363 S PECOS RD STE 206
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-6293
Mailing Address - Country:US
Mailing Address - Phone:317-617-6356
Mailing Address - Fax:
Practice Address - Street 1:526 S TONOPAH DR STE 200
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4013
Practice Address - Country:US
Practice Address - Phone:702-440-8440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-31
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV106S00000X
NVMI4209106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician