Individual
JACKSON CRYSES NIGHTSHADE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2300 W SAHARA AVE STE 800, LAS VEGAS, NV 89102-4397
(702) 545-5854
Mailing address
1027 S RAINBOW BLVD PMB 186, LAS VEGAS, NV 89145-6232
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
MI3202
NV
Other
Enumeration date
08/22/2012
Last updated
08/04/2023
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