Individual
CARL EDWARD JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.S. LPC
Contact information
Practice address
120 W BROADWAY ST, ALTUS, OK 73521-3802
(580) 954-5966
Mailing address
120 W BROADWAY ST, ALTUS, OK 73521-3802
(580) 954-5966
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
6694
OK
Other
Enumeration date
09/28/2011
Last updated
10/08/2020
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