| Full Name | |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 1801 Hwy 66, Catoosa, Oklahoma |
| Authorized Official Name and Position | Jackie Lee Scott (OWNER/CLINICIAN/SCHOOL PSYCHOLOGIST) |
| Authorized Official Contact | 9182644365 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
9195 E 580 Rd Catoosa OK 74015 Ph: (918) 739-0340 | 1801 Hwy 66 Catoosa OK 74015 Ph: (918) 264-4365 |
| NPI Number | 1912398322 |
|---|---|
| Provider Enumeration Date | 02/07/2015 |
| Last Update Date | 11/27/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912398322 | NPI | - | NPPES |
| 200402920B | Medicaid | OK | |
| 201122950A | Medicaid | KS | |
| 200575340A | Medicaid | OK |
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