Individual
RENITA CLEMONS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1870 S BOULDER AVE, TULSA, OK 74119-5234
(918) 585-1213
Mailing address
1870 S BOULDER AVE, TULSA, OK 74119-5234
(918) 585-1213
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
003811654
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1821127325
ODMHSAS
OK
Enumeration date
11/16/2016
Last updated
11/16/2016
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