Provider Demographics
NPI:1629385604
Name:MARSHALL, JODY (LCPC, LCADC-S)
Entity type:Individual
Prefix:
First Name:JODY
Middle Name:
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:LCPC, LCADC-S
Other - Prefix:
Other - First Name:MARSHALL
Other - Middle Name:MENTAL
Other - Last Name:HEALTH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCPC, LCADC-S
Mailing Address - Street 1:8565 S EASTERN AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-2906
Mailing Address - Country:US
Mailing Address - Phone:702-217-5639
Mailing Address - Fax:702-441-1262
Practice Address - Street 1:2840 E FLAMINGO RD STE A
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-5201
Practice Address - Country:US
Practice Address - Phone:702-217-5639
Practice Address - Fax:702-441-1262
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-11
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Multi-Specialty