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MR. VERNON THOMAS JAQUES LCSW

Clinical >> Social Worker >> Behavioral Health & Social Service Providers

Registrant NPI Number: 1689746554

Individual Registrant:
MR. VERNON THOMAS JAQUES LCSW
Gender: M
Not Sole Proprietor

Location and contact information for practice:
HWY 160 MP 394.3  KAYENTA, AZ 86033 US
Tel: 928-697-4183  Fax: 928-697-4189

Contact information for business:
PO BOX 368  KAYENTA, AZ 86033 US
Tel: 928-697-4183  Fax: 928-697-4189

Registration Information:
NPI: 1689746554
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
N1041C0700XBehavioral Health & Social Service Providers
Social Worker
Clinical
NMM-04628
Y1041C0700XBehavioral Health & Social Service Providers
Social Worker
NMC-10278

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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