Individual
MISS KRISTIE MICHELLE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3080 W 3RD ST, ELK CITY, OK 73644-4323
(580) 225-5136
(580) 225-5138
Mailing address
PO BOX 1106, ELK CITY, OK 73648-1106
(580) 225-5136
(580) 225-5138
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
10/28/2011
Last updated
10/28/2011
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