Deetra Jackson

NPI #1326485582 in Idabel, Oklahoma

Provider Information

NPI Number: 1326485582
Entity Type: Individual
Name: Deetra Jackson
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Counselor
Enumeration Date: May 29, 2013
Last Updated: May 29, 2013

Practice Location

Address: 411 S CENTRAL AVE
City: Idabel
State: Oklahoma
ZIP Code: 74745-6059
Phone: (580) 286-5045

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Counselor	101Y00000X	Primary

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