Healthcare Provider Details

I. General information

NPI: 1205417755
Provider Name (Legal Business Name): ALANA JACKSON AND ASSOCIATIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2021
Last Update Date: 04/16/2021
Certification Date: 04/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8760 S MARYLAND PKWY STE 101
LAS VEGAS NV
89123-6709
US

IV. Provider business mailing address

2510 E SUNSET RD # 5-74
LAS VEGAS NV
89120-3511
US

V. Phone/Fax

Practice location:
  • Phone: 702-738-3395
  • Fax: 702-368-6269
Mailing address:
  • Phone: 702-738-3395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ALANA JACKSON
Title or Position: LCADC
Credential: LCADC, CPC, MAC
Phone: 702-738-3395