JACK L. FORTENBERRY

CHOCTAW, OK
NPI1023155645
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy101Y00000X Counselor
(Licence: OK  3030)
Enumeration Date2007-01-31
Last Update Date2007-07-08
Business Address
Mr. JACK L. FORTENBERRY LMSW
14625 NE 23RD STREET
CHOCTAW, OK 73020
Phone number: 405-390-8131
Mailing Address
Mr. JACK L. FORTENBERRY LMSW
PO BOX 695
CHOCTAW, OK 73020-0695
Phone number: 405-390-8131
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