Provider Demographics
NPI:1326206145
Name:JACKSON, RICHARD HILLARY SR (LPC)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:HILLARY
Last Name:JACKSON
Suffix:SR
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7746 DORIS DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73162-4387
Mailing Address - Country:US
Mailing Address - Phone:405-722-4183
Mailing Address - Fax:
Practice Address - Street 1:1209 SOVEREIGN ROW
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73108-1824
Practice Address - Country:US
Practice Address - Phone:405-942-5570
Practice Address - Fax:405-942-5603
Is Sole Proprietor?:No
Enumeration Date:2008-05-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2149101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor