Individual
MATT PAUL JACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1020 EAST 43 HWY, STRINGTOWN, OK 74569
(580) 239-1004
Mailing address
1020 E 43 HWY, STRINGTOWN, OK 74569-9006
(580) 239-1004
(580) 889-3887
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
03/18/2015
Last updated
03/18/2015
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