Provider Demographics
NPI:1811288814
Name:JACKSON, MORRIS ALLEN (BA)
Entity type:Individual
Prefix:
First Name:MORRIS
Middle Name:ALLEN
Last Name:JACKSON
Suffix:
Gender:M
Credentials:BA
Other - Prefix:MR
Other - First Name:MORRIS
Other - Middle Name:ALLEN
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BA
Mailing Address - Street 1:12529 HIGH MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-1714
Mailing Address - Country:US
Mailing Address - Phone:405-819-7741
Mailing Address - Fax:
Practice Address - Street 1:12529 HIGH MEADOW DR
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-1714
Practice Address - Country:US
Practice Address - Phone:405-819-7741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-25
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor