Doctor Name: | MEGAN JACKSON |
NPI Number: | 1043676901 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | |
Business Practice Address: | 1308 N 1st Ave # A Durant, OK - 747012813 |
Business Phone Number: | 5809310300 |
Business Fax Number: | 5809310300 |
Mailing Address: | 89 Highland Dr, DURANT |
State: | OK |
Postal Code: | 747011786 |
Phone Number: | 5809165012 |
Fax Number: | 5809310300 |
NPI Enumeration Date: | 01/07/2016 |
NPI Last Update Date: | 01/07/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |