Individual
LATRICE VERNICE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1415 E 10TH ST, 2425 LENORE ST., SHAWNEE, OK 74801-7801
(405) 382-7623
Mailing address
1415 E 10TH ST, 2425 LENORE ST., SHAWNEE, OK 74801-7801
(405) 382-7623
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
11/23/2011
Last updated
01/21/2016
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