Individual
KIMBERLY JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1401 CHARLES PAGE BLVD, TULSA, OK 74127-8820
(918) 521-7053
(918) 516-0233
Mailing address
3720 SILVER OAK CT, TULSA, OK 74107-4050
(918) 521-7053
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
06/14/2017
Last updated
06/14/2017
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