Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | ||
Y | 103T00000X | Psychologist | ||
N | 103TC1900X | Counseling Psychologist |
NPI | 1023403474 |
---|---|
Provider Name | Yassi Kuo-Jackson |
First Address | Dallas, TX 75244-3995 |
Second Address | Las Vegas, NV 89154-9900 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2015 |
Last Update Date | 02/04/2015 |