Individual
MR. PHELTON GERRARD JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
N/A
Contact information
Practice address
4417 OASIS PLAINS AVE, NORTH LAS VEGAS, NV 89085-2334
(702) 688-1407
(702) 688-1407
Mailing address
4417 OASIS PLAINS AVE, NORTH LAS VEGAS, NV 89085-2334
(702) 688-1470
(702) 688-1470
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
04/25/2012
Last updated
04/25/2012
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