Individual
MR. JAMES RYAN JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4911 N PORTLAND AVE STE 111, OKLAHOMA CITY, OK 73112-6170
(316) 641-3039
Mailing address
1107 N DENMARK AVE, WICHITA, KS 67212-3036
(316) 641-3039
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
—
—
Other
Enumeration date
07/24/2012
Last updated
07/24/2012
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