Individual
IRIS JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
7790 CANYON DIABLO RD, LAS VEGAS, NV 89179-2068
(702) 400-6064
Mailing address
2228 REVERE ST, N LAS VEGAS, NV 89030-4011
(702) 521-4321
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
103TA0400X
Addiction (Substance Use Disorder) Psychologist
—
—
Other
Enumeration date
11/29/2018
Last updated
04/03/2019
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