Individual
KYRA CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3015 E SKELLY DR STE 103, TULSA, OK 74105-6344
(888) 882-0859
Mailing address
6010 S 73RD EAST AVE, TULSA, OK 74145-9329
(918) 613-0250
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
7392
OK
101YP2500X
Professional Counselor
Primary
7392
OK
171M00000X
Case Manager/Care Coordinator
—
—
171W00000X
Contractor
—
—
Other
Enumeration date
05/29/2015
Last updated
07/15/2022
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