Latrice Vernice Jackson

NPI #1275800997 in Shawnee, Oklahoma

Provider Information

NPI Number: 1275800997
Entity Type: Individual
Name: Latrice Vernice Jackson
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Counselor - Mental Health
Enumeration Date: Nov 23, 2011
Last Updated: Jan 21, 2016

Practice Location

Address: 1415 E 10TH ST
Address 2: 2425 LENORE ST.
City: Shawnee
State: Oklahoma
ZIP Code: 74801-7801
Phone: (405) 382-7623

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Counselor - Mental Health — Mental Health	101YM0800X	Primary

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