Provider Demographics
NPI:1144231689
Name:PEGG, JAMI DEL (LPC)
Entity type:Individual
Prefix:MRS
First Name:JAMI
Middle Name:DEL
Last Name:PEGG
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:JAMI
Other - Middle Name:DEL
Other - Last Name:LONGWITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LONGWITH
Mailing Address - Street 1:2810 LOCHBROOM WAY
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89044-8765
Mailing Address - Country:US
Mailing Address - Phone:816-304-4967
Mailing Address - Fax:816-373-3939
Practice Address - Street 1:2810 LOCHBROOM WAY
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89044-8765
Practice Address - Country:US
Practice Address - Phone:816-304-4967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS784101YP2500X
MO2001001598101YP2500X
NVCP1212R101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO495020109Medicaid
MO495020117Medicaid