Individual
MS. JACKIE LYNN SHAMSOLLAHI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, LPC
Contact information
Practice address
324 N WASHINGTON AVE, DURANT, OK 74701-3642
(580) 931-3008
Mailing address
401 NORTHRIDGE DR, DURANT, OK 74701-2561
(405) 880-7301
(580) 924-0379
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
1853
—
101YM0800X
Mental Health Counselor
1853
OK
Other
Enumeration date
10/10/2016
Last updated
08/21/2024
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