Individual
ABIGAIL MICHELLE JACQUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
1500 SW 104TH ST, OKLAHOMA CITY, OK 73159-7661
(405) 424-7711
Mailing address
1500 SW 104TH ST, OKLAHOMA CITY, OK 73159-7661
(405) 424-7711
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
10203
OK
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
09/10/2019
Last updated
07/08/2024
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