Individual provider · Type 1 NPI

Demetra Shan Jackson, B.S.

Mental Health Counselor · Oklahoma City, OK

NPI number 1619228095 Active

Practice location

1116 SW 59th St Apt 1
Oklahoma City, OK 73109-4908

Call (405) 618-9411 Map

Specialties and licenses

TaxonomyCodeLicense
Mental Health Counselor Primary 101YM0800XNone listed

Mental Health Counselor: Definition to come...

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About NPI 1619228095

Demetra Shan Jackson, B.S.'s National Provider Identifier is 1619228095, issued on Sep 26, 2012. The primary taxonomy on file is Mental Health Counselor (101YM0800X), and the practice location is in Oklahoma City, OK. The record was last updated on Sep 26, 2012.