Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | ||
Y | 101YP1600X | Pastoral Counselor | 03156 | OK |
N | 102L00000X | Psychologist | OK | |
N | 103T00000X | Psychologist | OK |
NPI | 1285944538 |
---|---|
Provider Name | Linda Jackson |
First Address | Oklahoma City, OK 73136-0421 |
Second Address | Oklahoma City, OK 73129-8727 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2010 |
Last Update Date | 31/01/2011 |