| Doctor Name: | JEANNE LEE JACKSON |
| NPI Number: | 1932314341 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MS, LPC |
| License Number: | 3302 |
| Business Practice Address: | 511 E 2nd St Heavener, OK - 749373419 |
| Business Phone Number: | 9186537450 |
| Business Fax Number: | 9186537279 |
| Mailing Address: | 18261 398th St, HOWE |
| State: | OK |
| Postal Code: | 749407305 |
| Phone Number: | 9186537718 |
| Fax Number: | 9186537279 |
| NPI Enumeration Date: | 05/11/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 3302 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OK |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |