Provider Demographics
NPI:1235483322
Name:JOUETT, JANELYN C
Entity type:Individual
Prefix:
First Name:JANELYN
Middle Name:C
Last Name:JOUETT
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 1:720 W CHEYENNE AVE
Mailing Address - Street 2:SUITE 20
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89030-7807
Mailing Address - Country:US
Mailing Address - Phone:702-719-9773
Mailing Address - Fax:
Practice Address - Street 1:720 W CHEYENNE AVE
Practice Address - Street 2:SUITE 20
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030-7807
Practice Address - Country:US
Practice Address - Phone:702-719-9773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-29
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1404248939Medicaid