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General NPI Number Information
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NPI Number | 1972842078
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Entity Type | Individual
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Provider Name | DEBBIE ANN JACKSON MFT-I
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Gender | Female
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Dates
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Enumeration Date | 02/08/2013
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Last Update Date | 02/08/2013
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Provider Practice Location Address
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Address Line | 6765 W CHARLESTON BLVD STE. #110
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City | LAS VEGAS
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State | NV
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Zip | 89146-2003
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Country | US
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Telephone | 702-884-0405
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Fax |
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Provider Business Mailing Address
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Address Line | 2840 SHAYLA BAY AVE
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City | NORTH LAS VEGAS
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State | NV
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Zip | 89086-1431
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Country | US
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Telephone | 702-884-0405
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 01486-L
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | M10274
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License Number State | NV
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