Doctor Name: | MRS. MICHELLE RENE CLARKSON |
NPI Number: | 1114285186 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MS, LPC |
License Number: | 2948 |
Business Practice Address: | 495 West Hope Ave. Vinita, OK - 74301 |
Business Phone Number: | 9182569200 |
Business Fax Number: | |
Mailing Address: | Po Box 38, DISNEY |
State: | OK |
Postal Code: | 743400038 |
Phone Number: | 9182569200 |
Fax Number: | |
NPI Enumeration Date: | 04/27/2012 |
NPI Last Update Date: | 04/27/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 2948 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OK |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |