Individual
MELONIE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
700 NW 1018TH AVE, WILBURTON, OK 74578-6605
(918) 448-0937
Mailing address
700 NW 1018TH AVE, WILBURTON, OK 74578-6605
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
02/11/2015
Last updated
02/11/2015
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