Individual
KEITH DARNELL JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
7550 CONSTANTINOPLE AVE, LAS VEGAS, NV 89129-6505
(702) 349-4042
Mailing address
4790 PENCARROW CT, LAS VEGAS, NV 89130-2372
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
—
—
104100000X
Social Worker
Primary
—
—
Other
Enumeration date
10/12/2012
Last updated
10/12/2012
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