Provider Demographics
NPI:1366585226
Name:JACKSON, WILLIAM SPENCER (PHD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:SPENCER
Last Name:JACKSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:880 W 12TH ST
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503-2601
Mailing Address - Country:US
Mailing Address - Phone:775-746-1869
Mailing Address - Fax:
Practice Address - Street 1:880 W 12TH ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89503-2601
Practice Address - Country:US
Practice Address - Phone:775-982-5318
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVLADC 00248-L101YA0400X
CA13587103TC0700X
NVPY0264103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)