Provider Demographics
NPI:1972842078
Name:JACKSON, DEBBIE ANN (MFT-I)
Entity Type:Individual
Prefix:MS
First Name:DEBBIE
Middle Name:ANN
Last Name:JACKSON
Suffix:
Gender:F
Credentials:MFT-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2840 SHAYLA BAY AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89086-1431
Mailing Address - Country:US
Mailing Address - Phone:702-884-0405
Mailing Address - Fax:
Practice Address - Street 1:6765 W CHARLESTON BLVD
Practice Address - Street 2:STE. #110
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-2003
Practice Address - Country:US
Practice Address - Phone:702-884-0405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-08
Last Update Date:2013-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV01486-L101YA0400X
NVM10274106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)