DEREK LUTHER JACKSON

HAYTI, MO
NPI1356859326
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date2018-01-12
Last Update Date2018-01-12
Business Address
Mr. DEREK LUTHER JACKSON B.S.
581 HIGHWAY J NORTH
HAYTI, MO 63851
Phone number: 573-359-2600
Mailing Address
Mr. DEREK LUTHER JACKSON B.S.
581 HIGHWAY J NORTH
HAYTI, MO 63851
Phone number: 573-359-2600
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