Individual
LEA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
3124 E APACHE ST, TULSA, OK 74110-2320
(918) 508-2712
Mailing address
3124 E APACHE ST, TULSA, OK 74110-2320
(918) 508-2712
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
12/17/2024
Last updated
12/17/2024
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