| Doctor Name: | MRS. LAVINA KAY CLARK |
| NPI Number: | 1417297680 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 126 E 6th St Pawhuska, OK - 740564204 |
| Business Phone Number: | 9182875425 |
| Business Fax Number: | 9182871096 |
| Mailing Address: | 2207 Bayliss Ave, PAWHUSKA |
| State: | OK |
| Postal Code: | 740569442 |
| Phone Number: | 9182875425 |
| Fax Number: | 9182871096 |
| NPI Enumeration Date: | 02/25/2013 |
| NPI Last Update Date: | 02/25/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 324500000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Residential Treatment Facilities |
| Taxonomy Classification: | Substance Abuse Rehabilitation Facility |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances. |