Provider Demographics
NPI:1326838814
Name:MINARD, JAYLEN ISAIAH
Entity type:Individual
Prefix:
First Name:JAYLEN
Middle Name:ISAIAH
Last Name:MINARD
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8149 OLD FEDERAL RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-8009
Mailing Address - Country:US
Mailing Address - Phone:334-523-1331
Mailing Address - Fax:312-386-6820
Practice Address - Street 1:8149 OLD FEDERAL RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-8009
Practice Address - Country:US
Practice Address - Phone:334-523-1331
Practice Address - Fax:312-386-6820
Is Sole Proprietor?:No
Enumeration Date:2025-05-08
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician