Individual
LINDA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2817 SE 47TH ST, OKLAHOMA CITY, OK 73129-8727
(405) 788-5687
Mailing address
PO BOX 11421, OKLAHOMA CITY, OK 73136-0421
(405) 788-5687
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
101YP1600X
Pastoral Counselor
Primary
03156
OK
102L00000X
Psychoanalyst
—
OK
Other
Enumeration date
10/19/2010
Last updated
01/31/2011
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