Individual
LINDA CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LADC/MH CANDIDATE
Contact information
Practice address
16301 SONOMA PARK DR, EDMOND, OK 73013-2091
(405) 748-0789
Mailing address
PO BOX 20433, PO BOX 20433, OKLAHOMA CITY, OK 73156-0433
(405) 748-0789
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
76
OK
225700000X
Massage Therapist
OCC-05967
OK
Other
Enumeration date
11/23/2014
Last updated
01/20/2015
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