Provider Demographics
NPI:1588922553
Name:JACKSON, CINDY SHELLY ANN (LCSW)
Entity type:Individual
Prefix:MS
First Name:CINDY
Middle Name:SHELLY ANN
Last Name:JACKSON
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:732 S 6TH ST # 4942
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89101-6948
Mailing Address - Country:US
Mailing Address - Phone:702-268-9977
Mailing Address - Fax:702-776-7750
Practice Address - Street 1:732 S 6TH ST # 4942
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89101-6948
Practice Address - Country:US
Practice Address - Phone:702-268-9977
Practice Address - Fax:702-776-7750
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-27
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5580-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical