Provider Demographics
NPI:1467825851
Name:JACKSON-MCGEE, GABRIELLE DE'JON
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:DE'JON
Last Name:JACKSON-MCGEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8450 W CHARLESTON BLVD
Mailing Address - Street 2:APT 1018
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-9010
Mailing Address - Country:US
Mailing Address - Phone:269-753-4552
Mailing Address - Fax:
Practice Address - Street 1:911 N BUFFALO DR
Practice Address - Street 2:STE 213
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0379
Practice Address - Country:US
Practice Address - Phone:702-942-1774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-05
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV145600645103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst