Organization
ELEVATE LIFE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIE PEARL JACKSON BACHELOR (OWNER)
(702) 630-5009
Entity
Organization
Contact information
Practice address
2605 RAINBOW GLOW ST, NORTH LAS VEGAS, NV 89030-3709
(702) 630-5009
Mailing address
2605 RAINBOW GLOW ST, NORTH LAS VEGAS, NV 89030-3709
(702) 630-5009
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
04/20/2010
Last updated
04/20/2010
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