Individual
GENIE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1222 10TH ST STE 211, WOODWARD, OK 73801-3156
(580) 256-8615
(580) 256-8609
Mailing address
1222 10TH ST STE 211, WOODWARD, OK 73801-3156
(580) 256-8615
(580) 256-8609
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
10/18/2007
Last updated
10/18/2007
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