| Doctor Name: | MRS. GINA CLARK |
| NPI Number: | 1023151784 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LPC |
| License Number: | 3797 |
| Business Practice Address: | 800 E 6th Ave Ste B Stillwater, OK - 740743732 |
| Business Phone Number: | 4053721250 |
| Business Fax Number: | |
| Mailing Address: | 1321 N Jardot Rd, STILLWATER |
| State: | OK |
| Postal Code: | 740758531 |
| Phone Number: | 4053723010 |
| Fax Number: | |
| NPI Enumeration Date: | 02/14/2007 |
| NPI Last Update Date: | 04/27/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 3797 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OK |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |