| Doctor Name: | MRS. KRISTI DENISE JACK |
| NPI Number: | 1275817611 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 717 Us 70 Kingston, OK - 73439 |
| Business Phone Number: | 5805647308 |
| Business Fax Number: | |
| Mailing Address: | 1101 S Oregon Ave, ATOKA |
| State: | OK |
| Postal Code: | 745252879 |
| Phone Number: | 5802392373 |
| Fax Number: | |
| NPI Enumeration Date: | 10/04/2011 |
| NPI Last Update Date: | 06/19/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101Y00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |