MR. Jack L. Fortenberry, LMSW

NPI #1023155645 in Choctaw, Oklahoma

Provider Information

NPI Number: 1023155645
Entity Type: Individual
Name: MR. Jack L. Fortenberry, LMSW
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Counselor
Credential: LMSW
Enumeration Date: Jan 31, 2007
Last Updated: Jul 8, 2007

Practice Location

Address: 14625 NE 23RD STREET
City: Choctaw
State: Oklahoma
ZIP Code: 73020
Phone: (405) 390-8131

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Counselor	101Y00000X	Primary

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