Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst |
NPI | 1013342823 |
---|---|
Provider Name | Damarcus M Jackson |
First Address | Las Vegas, NV 89149-4459 |
Second Address | Las Vegas, NV 89149-4459 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/09/2013 |
Last Update Date | 11/09/2013 |