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1861768715
MICKEY DEWAYNE JACK
ATOKA, OK
NPI
1861768715
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
101YM0800X Counselor, Mental Health
Enumeration Date
2012-03-26
Last Update Date
2012-03-26
Business Address
Mr. MICKEY DEWAYNE JACK BHRS
303 E COURT ST
ATOKA, OK 74525-2047
Phone number: 580-889-3399
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Mailing Address
Mr. MICKEY DEWAYNE JACK BHRS
126 W 4TH ST
ATOKA, OK 74525-2501
Phone number: 580-230-1613
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