Individual
GRACE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5330 E 31ST ST, TULSA, OK 74135-5076
(918) 712-8062
Mailing address
5330 E 31ST ST, TULSA, OK 74135-5076
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
02/21/2024
Last updated
10/14/2024
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