| Doctor Name: | DEETRA JACKSON |
| NPI Number: | 1326485582 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 411 S Central Ave Idabel, OK - 747456059 |
| Business Phone Number: | 5802865045 |
| Business Fax Number: | 5802865721 |
| Mailing Address: | 107 S High St, ANTLERS |
| State: | OK |
| Postal Code: | 745233818 |
| Phone Number: | 5802982830 |
| Fax Number: | 5802986723 |
| NPI Enumeration Date: | 05/29/2013 |
| NPI Last Update Date: | 05/29/2013 |
| 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 |