Chanda M Jackson, LCPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

CP5102 Issued in NV

Practice address

9402 W Lake Mead Blvd
Las Vegas, NV 89134-8312

Phone

(725) 877-1999

NPI assigned

Feb 17, 2014

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Ms. Chanda M Kelly Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1392595200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706313600000",
    "number": "1295159911",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9402 W LAKE MEAD BLVD",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891348312",
            "telephone_number": "725-800-1146"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9402 W LAKE MEAD BLVD",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891348312",
            "telephone_number": "725-877-1999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "CHANDA",
        "middle_name": "M",
        "name_prefix": "Mrs.",
        "credential": "LCPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-02-17",
        "last_updated": "2024-01-27",
        "certification_date": "2024-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "AZ",
            "license": "21472",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "NV",
            "license": "CP5102",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CHANDA",
            "last_name": "KELLY",
            "middle_name": "M",
            "prefix": "MS.",
            "credential": "LCPC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Carrie Jackson
• Casey Jackson
• Catherine Jackson
• Chakyla Jackson
• Chalonda Jackson
• Charie Jackson
• Charlene Jackson
• Charles Jackson
• Charles Lee Jackson Jr., PTA
• Cherina Laquelle Jackson, LMSW, CSW INTERN

• Professional Counselor in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Professional Counselor in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2024; 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.