Individual
MR. EMMANUEL JACKSON-BISHOP
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
417 EAST 3RD STREET, OKMULGEE, OK 74447
(918) 636-4212
Mailing address
417 E 3RD ST, OKMULGEE, OK 74447-4018
(918) 636-4212
Taxonomy
Speciality
Code
Description
License number
State
106E00000X
Assistant Behavior Analyst
TBD
OK
171M00000X
Case Manager/Care Coordinator
Primary
321122
OK
Other
Enumeration date
08/14/2024
Last updated
09/30/2025
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