Individual
MS. ANDREA LUTHELLE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S. EDUCATION
Contact information
Practice address
1501 NW 34TH ST, OKLAHOMA CITY, OK 73118-3203
(405) 223-7793
Mailing address
1501 NW 34TH ST, OKLAHOMA CITY, OK 73118-3203
(405) 223-7793
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
07/10/2012
Last updated
07/10/2012
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