Individual
MR. MICKEY DEWAYNE JACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
BHRS
Contact information
Practice address
303 E COURT ST, ATOKA, OK 74525-2047
(580) 889-3399
Mailing address
126 W 4TH ST, ATOKA, OK 74525-2501
(580) 230-1613
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
03/26/2012
Last updated
03/26/2012
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