Organization
MADISON CLARK, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MADISON ANNE CLARK M.ED., LPC (COUNSELOR)
(214) 435-6145
Entity
Organization
Contact information
Practice address
711 W MAIN STREET, NORMAN, OK 73069
(405) 882-4960
Mailing address
1213 LESLIE LN, NORMAN, OK 73069-4403
(214) 435-6145
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
5327
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1407195183
—
OK
Enumeration date
04/16/2014
Last updated
05/01/2015
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