Individual
JANIS JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
8600 W CHARLESTON BLVD, LAS VEGAS, NV 89117-5407
(702) 756-3632
Mailing address
900 N 24TH ST, LAS VEGAS, NV 89101-1416
(702) 845-0960
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
NV20171061954
NV
Other
Enumeration date
05/22/2018
Last updated
05/22/2018
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