Individual
MR. JACKSON KYLE TEFERTILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
2325 S HARVARD AVE, TULSA, OK 74114-3300
(918) 712-4301
(918) 560-1399
Mailing address
650 S PEORIA AVE, TULSA, OK 74120-4429
(918) 587-9471
(918) 560-1399
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
12/11/2012
Last updated
09/04/2014
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