Individual
LAVON JO CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
111 S TREATY RD, MIAMI, OK 74354-5327
(918) 540-1511
Mailing address
111 S TREATY RD, MIAMI, OK 74354-5327
(918) 540-1511
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
07/17/2017
Last updated
07/21/2022
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