Provider Demographics
NPI:1336408459
Name:BESAW, JANE WISE
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:WISE
Last Name:BESAW
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 1:1342 LEONARD RD
Mailing Address - Street 2:
Mailing Address - City:GARDNERVILLE
Mailing Address - State:NV
Mailing Address - Zip Code:89460-8346
Mailing Address - Country:US
Mailing Address - Phone:775-781-2481
Mailing Address - Fax:
Practice Address - Street 1:1512 US HIGHWAY 395 N # 32E
Practice Address - Street 2:
Practice Address - City:GARDNERVILLE
Practice Address - State:NV
Practice Address - Zip Code:89410-5282
Practice Address - Country:US
Practice Address - Phone:702-332-8466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-09
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCP5137101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional