Active NPI
Michelle Laray Jackson, CPC
- Professional Counselor
- North Las Vegas, NV
National Provider Identifier
1396253258
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- Practice address
- 6202 Flaming Arrow Rd
North Las Vegas, NV 89031-1646 - Phone
- (812) 306-7795
- NPI assigned
- Jan 12, 2018
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | NV | Primary |
Addresses
Primary practice location
6202 Flaming Arrow Rd
North Las Vegas, NV 89031-1646
Mailing address
6202 Flaming Arrow Rd
North Las Vegas, NV 89031-1646
Phone (812) 306-7795
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NV
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240226003670 | NV | Order and Referring Only - Mental Health Counselor | 5092150375 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1515715200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1700006400000",
"number": "1396253258",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6202 FLAMING ARROW RD",
"city": "NORTH LAS VEGAS",
"state": "NV",
"postal_code": "890311646",
"telephone_number": "812-306-7795"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6202 FLAMING ARROW RD",
"city": "NORTH LAS VEGAS",
"state": "NV",
"postal_code": "890311646",
"telephone_number": "812-306-7795"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "MICHELLE",
"middle_name": "LARAY",
"credential": "CPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-01-12",
"last_updated": "2023-11-15",
"certification_date": "2023-11-15",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "NV",
"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 Nov 15, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.