Provider Demographics
NPI:1316083066
Name:PARIS, JEFFREY WAYNE (MS)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:WAYNE
Last Name:PARIS
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4801 E MCKELLIPS RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85215-2527
Mailing Address - Country:US
Mailing Address - Phone:480-505-1064
Mailing Address - Fax:
Practice Address - Street 1:4801 E MCKELLIPS RD
Practice Address - Street 2:SUITE 104
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85215-2527
Practice Address - Country:US
Practice Address - Phone:480-505-1064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC 2217101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional