Individual
MRS. DANA LYNN JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LADC UNDER SUPER
Contact information
Practice address
2448 E. 81ST STREET, SUITE 4824 / CITIPLEXTOWERS, TULSA, OK 74137-1814
(918) 486-9996
Mailing address
2413 LARKHAVEN ST, NORMAN, OK 73071-4326
(405) 310-6108
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
P082039069
—
OK
Enumeration date
03/24/2011
Last updated
10/15/2011
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