Provider Demographics
NPI:1992883987
Name:COLLINS-JACKSON, PATRICIA JEAN (MS, LBP, LPC)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:JEAN
Last Name:COLLINS-JACKSON
Suffix:
Gender:F
Credentials:MS, LBP, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22022 E 143RD ST S
Mailing Address - Street 2:
Mailing Address - City:COWETA
Mailing Address - State:OK
Mailing Address - Zip Code:74429-6272
Mailing Address - Country:US
Mailing Address - Phone:918-279-9861
Mailing Address - Fax:
Practice Address - Street 1:4009 EUFAULA AVE
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74403-1132
Practice Address - Country:US
Practice Address - Phone:918-682-2841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK0131101YM0800X
OK3211101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional