Individual
MARCUS JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
320 PRINCESS AVE, NORTH LAS VEGAS, NV 89030-3809
(702) 573-5812
Mailing address
320 PRINCESS AVE, NORTH LAS VEGAS, NV 89030-3809
Taxonomy
Speciality
Code
Description
License number
State
103TR0400X
Rehabilitation Psychologist
—
—
225400000X
Rehabilitation Practitioner
Primary
—
—
Other
Enumeration date
09/27/2011
Last updated
09/27/2011
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