Provider Demographics
NPI:1215558143
Name:JESSICA MIX MFT, INC.
Entity type:Organization
Organization Name:JESSICA MIX MFT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:MIX-TESMER
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:702-673-7796
Mailing Address - Street 1:8414 FARM RD STE 180
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89131-8007
Mailing Address - Country:US
Mailing Address - Phone:702-673-7796
Mailing Address - Fax:
Practice Address - Street 1:5785 CENTENNIAL CENTER BLVD STE 240
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-7108
Practice Address - Country:US
Practice Address - Phone:702-673-7796
Practice Address - Fax:866-611-8528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-01
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1205149044OtherINDIVIDUAL NPI
NV1215558143OtherGROUP NPI