Individual
DEETRA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
411 S CENTRAL AVE, IDABEL, OK 74745-6059
(580) 286-5045
(580) 286-5721
Mailing address
107 S HIGH ST, ANTLERS, OK 74523-3818
(580) 298-2830
(580) 298-6723
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
05/29/2013
Last updated
05/29/2013
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