JAYDA KEYERRA BLOUNT SHAW LCPC
NPI 1891349148
Counselor - Professional in Truckee, CA
Active since July 25, 2019
10775 PIONEER TRL STE 215, TRUCKEE, CA 96161(415) 424-4266(415) 520-6633 Get Directions Write a Review
About Jayda Keyerra Blount Shaw Lcpc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
JAYDA KEYERRA BLOUNT SHAW LCPC (NPI 1891349148) is an individual professional provider in Truckee, California, licensed in Maryland (LC12586) and active in the NPI registry since July 2019.
NPPES Registry Identity
NPI1891349148
Entity TypeIndividualFemale
Primary Taxonomy101YP2500X
Provider Legal NameJAYDA KEYERRA BLOUNT SHAWCredential: LCPC
Location Address10775 PIONEER TRL STE 215Truckee, CA 96161-0234
Mailing Address10775 Pioneer Trl Ste 215Truckee, CA 96161-0234 · (415) 424-4266 · Fax (415) 520-6633
Phone(415) 424-4266
Fax(415) 520-6633
Sole ProprietorYes
Enumeration DateJuly 25, 2019
Last NPPES UpdateNovember 6, 20223 updates tracked since enumeration
NPPES CertifiedNovember 6, 2022
✔ NPI 1891349148 is a valid, active identifier and passes the ISO check-digit test.
Specialties & Licenses 2
★ Primary SpecialtyCounselor · ProfessionalBehavioral Health & Social Service Providers
Taxonomy Code101YP2500X
License✔ Licensed in MD · LC12586
Also ListedCounselor · Addiction (Substance Use Disorder)Taxonomy 101YA0400X · License ADT1995 (MD)
10775 PIONEER TRL STE 215, Truckee, CA 96161
Other Names 1
Former Name (1)Jayda Keyerra Blount
Other Providers at the Same Location NPPES 20
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1891349148, enumerated as an "individual" on July 25, 2019.
The provider is located at 10775 PIONEER TRL STE 215 TRUCKEE, CA 96161 and the phone number is (415) 424-4266.
Counselor with taxonomy code 101YP2500X and a focus in Professional.
