Provider Demographics
NPI:1912124488
Name:MEEKS, JACK EDWARD (CADC)
Entity type:Individual
Prefix:MR
First Name:JACK
Middle Name:EDWARD
Last Name:MEEKS
Suffix:
Gender:M
Credentials:CADC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:122 S. BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820
Mailing Address - Country:US
Mailing Address - Phone:580-332-8773
Mailing Address - Fax:580-332-8774
Practice Address - Street 1:122 S. BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820
Practice Address - Country:US
Practice Address - Phone:580-332-8773
Practice Address - Fax:580-332-8774
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)