Active NPI
Gloria Jackson
- Addiction (Substance Use Disorder) Counselor
- Las Vegas, NV
National Provider Identifier
1619371507
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 101YA0400X
- Practice address
- 800 N. Rainbow Blvd Suite 215
Las Vegas, NV 89107 - Phone
- (702) 968-0231
- NPI assigned
- Oct 21, 2014
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | 103K000000X | NV | |
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 101YA0400X | NV | Primary |
Addresses
Primary practice location
800 N. Rainbow Blvd Suite 215
Las Vegas, NV 89107
Mailing address
800.N.Raibow Blvd Suite 215
Las Vegas, NV 89107-1103
Phone (702) 968-0231
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 22540000X | Medicaid | NV |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 101YA0400X | NV | MD | Addiction (Substance Use Disorder) Counselor |
| 103K000000X | NV | MD | Behavioral Analyst |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1413849600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1413849600000",
"number": "1619371507",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "800.N.RAIBOW BLVD SUITE 215",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891071103",
"telephone_number": "702-968-0231"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "800 N. RAINBOW BLVD SUITE 215",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "89107",
"telephone_number": "702-968-0231"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "GLORIA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-10-21",
"last_updated": "2014-10-21",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "NV",
"license": "103K000000X",
"primary": false
},
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "NV",
"license": "101YA0400X",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "22540000X",
"state": "NV"
}
],
"endpoints": [],
"other_names": []
}Other providers in Las Vegas, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.