Individual
AMANDA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MHR LPC
Contact information
Practice address
4045 NW 64TH ST STE 520, OKLAHOMA CITY, OK 73116-8608
(405) 842-4911
Mailing address
4045 NW 64TH ST STE 520, OKLAHOMA CITY, OK 73116-8608
(405) 842-4911
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
LPC07226
OK
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
08/08/2014
Last updated
02/01/2024
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