MEDICARE: MS. JESSICA HARRISON

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	101Y00000X	Counselor
2	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1760743488
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JESSICA HARRISON

Provider Business Mailing Address
First Line	:	913 N JONES BLVD
Second Line	:	APT 203
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-1625
Country	:	US
Telephone Number	:	702-274-4465
Fax Number	:

Provider Business Practice Location Address
First Line	:	2715 E RUSSELL RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-2426
Country	:	US
Telephone Number	:	702-848-1696
Fax Number	:

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

Provider Enumeration Date	:	05/30/2012
Last Update Date	:	07/21/2022

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