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1194001560
KRISTIE MICHELLE JACKSON
ELK CITY, OK
NPI
1194001560
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
101YM0800X Counselor, Mental Health
Enumeration Date
2011-10-28
Last Update Date
2011-10-28
Business Address
Miss KRISTIE MICHELLE JACKSON
3080 W 3RD ST
ELK CITY, OK 73644-4323
Phone number: 580-225-5136
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Mailing Address
Miss KRISTIE MICHELLE JACKSON
PO BOX 1106
ELK CITY, OK 73648-1106
Phone number: 580-225-5136
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