MEDICARE: MISS BRITTANY JACKSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor
2	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1518303825
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS BRITTANY JACKSON

Provider Business Mailing Address
First Line	:	2910 W GILMORE AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-0415
Country	:	US
Telephone Number	:	702-673-8209
Fax Number	:

Provider Business Practice Location Address
First Line	:	2755 E DESERT INN RD STE 160
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121
Country	:	US
Telephone Number	:	702-538-8420
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/14/2013
Last Update Date	:	07/27/2018

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Directions to “ MISS BRITTANY JACKSON ” Practice Location

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