Organization Name: | JACKIE HORTON LLC |
NPI Number: | 1154702256 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JACKIE HORTON (OWNER) |
Mailing Address: | Rr 4 Box 854 Coalgate |
State: | OK US |
Postal Code: | 745389624 |
Phone Number: | 5803995398 |
Fax Number: | 5809272346 |
NPI Enumeration Date: | 06/15/2015 |
NPI Last Update Date: | 06/15/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 5730 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OK |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |