Individual ProviderPenny Ann JacksonCounselorBehavioral Health & Social Service ProvidersPractice Address1240 W Owens Ave Ste 3, Las Vegas, NV 89106-2452(702) 877-9850PECOS EnrollmentBased on the most recent information from CMS, provider Penny Ann 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 4 days ago.Profile DetailsProvider ID1437451184Provider TypeIndividualFull NameJackson, Penny AnnTitleMs.CredentialM.A., LADCGenderFemaleSole ProprietorNoEnumeration Date12/1/2010Last Updated12/1/2010Contact InformationPractice LocationPractice Address1240 W Owens Ave Ste 3, Las Vegas, NV 89106-2452Phone(702) 877-9850Fax(702) 877-9870Mailing LocationMailing Address1240 W Owens Ave Ste 3, Las Vegas, NV 89106-2452Phone(702) 877-9850Fax(702) 877-9870Provider TaxonomiesCodeDescriptionLicenseCode101YM0800XPrimaryDescriptionCounselorBehavioral Health & Social Service ProvidersLicenseUnlisted IssuerCode101Y00000XDescriptionCounselorBehavioral Health & Social Service ProvidersLicenseUnlisted IssuerNevadaCode101YA0400XDescriptionCounselorBehavioral Health & Social Service ProvidersLicenseUnlisted Issuer