Individual
MR. TANNER CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.S.
Contact information
Practice address
326 W 11TH ST, SHAWNEE, OK 74801-6710
(580) 262-0250
Mailing address
1806 N NAIL PKWY, MOORE, OK 73160-4636
(580) 262-0250
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
—
—
Other
Enumeration date
11/10/2015
Last updated
11/10/2015
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