Individual
MS. SHELLY DENISE JACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BHRS CM II
Contact information
Practice address
1088 S GIN RD, ATOKA, OK 74525-7378
(580) 239-2071
(580) 509-5041
Mailing address
1185 S OREGON AVE, ATOKA, OK 74525-2879
(580) 230-3079
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
OK
Other
Enumeration date
01/11/2012
Last updated
10/30/2018
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