Provider Demographics
NPI:1427499177
Name:DEBATTISTA, JERUSHA (MS)
Entity type:Individual
Prefix:
First Name:JERUSHA
Middle Name:
Last Name:DEBATTISTA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 S JONES BLVD STE 220
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-1233
Mailing Address - Country:US
Mailing Address - Phone:702-955-1627
Mailing Address - Fax:702-486-6057
Practice Address - Street 1:6171 W CHARLESTON BLVD BLDG 7
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-1126
Practice Address - Country:US
Practice Address - Phone:702-955-1627
Practice Address - Fax:702-486-6057
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-10
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV01364106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist