NPIMap

Organization Active NPI

Elevate Life

  • Mental Health Counselor
  • North Las Vegas, NV
National Provider Identifier
1033436787
Registry record updated Apr 20, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
ELEVATE LIFE
Practice address
2605 Rainbow Glow St
North Las Vegas, NV 89030-3709
Phone
(702) 630-5009
NPI assigned
Apr 20, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Willie Pearl Jackson, BACHELOR
Title
Owner
Phone
(702) 630-5009

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X Primary

Addresses

Primary practice location

2605 Rainbow Glow St
North Las Vegas, NV 89030-3709

Mailing address

2605 Rainbow Glow St
North Las Vegas, NV 89030-3709
Phone (702) 630-5009

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1271721600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1271721600000",
    "number": "1033436787",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2605 RAINBOW GLOW ST",
            "city": "NORTH LAS VEGAS",
            "state": "NV",
            "postal_code": "890303709",
            "telephone_number": "702-630-5009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2605 RAINBOW GLOW ST",
            "city": "NORTH LAS VEGAS",
            "state": "NV",
            "postal_code": "890303709",
            "telephone_number": "702-630-5009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELEVATE LIFE",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-20",
        "last_updated": "2010-04-20",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "WILLIE",
        "authorized_official_middle_name": "PEARL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "702-630-5009",
        "authorized_official_credential": "BACHELOR"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in North Las Vegas, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.