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General NPI Number Information
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NPI Number | 1154702256
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Entity Type | Organization
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Legal Business Name | JACKIE HORTON LLC
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Dates
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Enumeration Date | 06/15/2015
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Last Update Date | 06/15/2015
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Provider Practice Location Address
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Address Line | RR 4 BOX 854
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City | COALGATE
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State | OK
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Zip | 74538-9624
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Country | US
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Telephone | 580-399-5398
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Fax | 580-927-2346
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Provider Business Mailing Address
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Address Line | RR 4 BOX 854
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City | COALGATE
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State | OK
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Zip | 74538-9624
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Country | US
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Telephone | 580-399-5398
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Fax | 580-927-2346
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Authorized Official
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Title or Position | OWNER
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Name | JACKIE HORTON
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Credential | LPC
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Telephone | 580-399-5398
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 5730
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License Number State | OK
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