Active NPI
Jaylesse Shabri Clark
- Behavior Analyst
- Chino, CA
National Provider Identifier
1831834332
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- Y3408986
- Practice address
- 16379 E Preserve Loop Unit 2150
Chino, CA 91708-9408 - Phone
- (725) 724-6914
- NPI assigned
- Apr 29, 2022
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | Y3408986 | CA | Primary |
Addresses
Primary practice location
16379 E Preserve Loop Unit 2150
Chino, CA 91708-9408
Mailing address
16379 E Preserve Loop Unit 2150
Chino, CA 91708-9408
Phone (725) 724-6914
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| Y3408986 | CA | MD | Behavioral Analyst |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1651190400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1651190400000",
"number": "1831834332",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16379 E PRESERVE LOOP UNIT 2150",
"city": "CHINO",
"state": "CA",
"postal_code": "917089408",
"telephone_number": "725-724-6914"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "16379 E PRESERVE LOOP UNIT 2150",
"city": "CHINO",
"state": "CA",
"postal_code": "917089408",
"telephone_number": "725-724-6914"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "JAYLESSE",
"middle_name": "SHABRI",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-04-29",
"last_updated": "2022-04-29",
"certification_date": "2022-04-29",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "CA",
"license": "Y3408986",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chino, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.