Individual
MRS. LAVINA KAY CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
126 E 6TH ST, PAWHUSKA, OK 74056-4204
(918) 287-5425
(918) 287-1096
Mailing address
2207 BAYLISS AVE, PAWHUSKA, OK 74056-9442
(918) 287-5425
(918) 287-1096
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
02/25/2013
Last updated
02/25/2013
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