Individual
TAVEUS JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4785 IDAHO AVE, LAS VEGAS, NV 89104-5911
(702) 857-4423
Mailing address
4785 IDAHO AVE, LAS VEGAS, NV 89104-5911
(702) 857-4423
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
12/02/2014
Last updated
12/02/2014
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