Individual
JACK SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
933 SW 3RD ST, MOORE, OK 73160-2261
(405) 822-1424
Mailing address
933 SW 3RD ST, MOORE, OK 73160-2261
(405) 822-1424
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LPC07653
OK
104100000X
Social Worker
—
—
Other
Enumeration date
06/06/2014
Last updated
03/02/2023
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