Individual ProviderTerri JacksonCounselorBehavioral Health & Social Service ProvidersPractice Address1104 Allure Dr, Las Vegas, NV 89128-2095(702) 561-2725(702) 100-0000PECOS EnrollmentBased on the most recent information from CMS, provider Terri Jackson does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1699075853Provider TypeIndividualFull NameJackson, TerriGenderFemaleSole ProprietorYesEnumeration Date10/21/2010Last Updated1/21/2022Contact InformationPractice LocationPractice Address1104 Allure Dr, Las Vegas, NV 89128-2095Phone(702) 561-2725FaxUnlisted FaxMailing LocationMailing AddressPO Box 753394, Las Vegas, NV 89136-3394Phone(702) 100-0000FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode101YM0800XPrimaryDescriptionCounselorBehavioral Health & Social Service ProvidersLicenseCI0335NevadaCode225400000XDescriptionRehabilitation PractitionerRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersLicenseUnlisted Issuer