Individual
JACQUELINE RENEE CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BA, HRC
Contact information
Practice address
118 E MAIN ST, HOLDENVILLE, OK 74848-3208
(405) 379-5256
Mailing address
17964 COUNTY ROAD 1500, ADA, OK 74820-4717
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
08/10/2007
Last updated
08/10/2007
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