Jerrell Shanae White

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

Practice address

4535 W Russell Rd Ste 15
Las Vegas, NV 89118-2258

Phone

(702) 368-2380

NPI assigned

Apr 16, 2021

Last updated

Apr 16, 2021By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• The Center for Change LLC

  dba Center for Change

  • Clinical Social Worker
  • Las Vegas, NV
  • NPI 1164083515
  NPD
• The Center for Change LLC

  • Clinical Psychologist
  • Las Vegas, NV
  • NPI 1689142945
  NPD

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

{
    "created_epoch": "1618531200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618531200000",
    "number": "1629659198",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "312 BURGOS AVE",
            "city": "NORTH LAS VEGAS",
            "state": "NV",
            "postal_code": "890304718"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4535 W RUSSELL RD STE 15",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891182258",
            "telephone_number": "702-368-2380"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WHITE",
        "first_name": "JERRELL",
        "middle_name": "SHANAE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-04-16",
        "last_updated": "2021-04-16",
        "certification_date": "2021-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "www.cfcnv.com",
            "affiliation": "N",
            "endpointDescription": "www.cfcnv.com",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "312 Burgos Ave",
            "city": "North Las Vegas",
            "state": "NV",
            "country_code": "US",
            "postal_code": "890304718",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jason Andrew White
• Jeanne White
• Jeremiah White
• Jeremy White, LSW
• Jeremy White, RBT
• Jill Helena White
• Johnathan R. White, DDS
• Jontau White
• Jordan Renee White, QMHA
• Joseph White, DPT

• Behavior Technician in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Behavior Technician in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2021; 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.