Individual
MISS JESSICCA DIANE ST. CLAIR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BA
Contact information
Practice address
1424 W TEXAS ST, DURANT, OK 74701-5752
(580) 380-5220
Mailing address
PO BOX 5253, DURANT, OK 74702-5253
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
OK
390200000X
Student in an Organized Health Care Education/Training Program
L999552021
OK
Other
Enumeration date
05/25/2011
Last updated
05/29/2011
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