NPIMap

Organization Active NPI

Mohave Neurofeedback Clinic, LLC

  • Professional Counselor
  • Kingman, AZ
National Provider Identifier
1174249015
Registry record updated Mar 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
Legal business name
MOHAVE NEUROFEEDBACK CLINIC, LLC
Practice address
2701 E Andy Devine Ave Ste 101
Kingman, AZ 86401-4889
Phone
(928) 263-1045
Fax
(928) 597-5172
NPI assigned
Oct 12, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Audra Nicole Jalbert, LPCNPI 1962955161
Title
Owner, Counselor
Phone
(928) 263-1045

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101YP2500X Primary

Addresses

Primary practice location

2701 E Andy Devine Ave Ste 101
Kingman, AZ 86401-4889

Mailing address

2701 E Andy Devine Ave Ste 101
Kingman, AZ 86401-4889
Phone (928) 263-1045

Other names 1

  • Mohave Neurofeedback Doing business as

National Provider Directory

National Provider Directory

Locations

1570 E Northern Ave
Ste C
Kingman, AZ 86409
Phone (928) 263-1045

2701 E Andy Devine Ave
Ste 101
Kingman, AZ 86401
Phone (928) 263-1045

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1665532800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1742169600000",
    "number": "1174249015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2701 E ANDY DEVINE AVE STE 101",
            "city": "KINGMAN",
            "state": "AZ",
            "postal_code": "864014889",
            "telephone_number": "928-263-1045",
            "fax_number": "928-597-5172"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2701 E ANDY DEVINE AVE STE 101",
            "city": "KINGMAN",
            "state": "AZ",
            "postal_code": "864014889",
            "telephone_number": "928-263-1045",
            "fax_number": "928-597-5172"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOHAVE NEUROFEEDBACK CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-12",
        "last_updated": "2025-03-17",
        "certification_date": "2025-03-17",
        "status": "A",
        "authorized_official_last_name": "JALBERT",
        "authorized_official_first_name": "AUDRA",
        "authorized_official_middle_name": "NICOLE",
        "authorized_official_title_or_position": "OWNER, COUNSELOR",
        "authorized_official_telephone_number": "928-263-1045",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mohave Neurofeedback",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mohave Neurofeedback",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kingman, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.