Individual
JEROD CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
907 W CADDO ST, CLEVELAND, OK 74020-4201
(918) 607-5576
Mailing address
907 W CADDO ST, CLEVELAND, OK 74020-4201
(918) 607-5576
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
01/11/2023
Last updated
01/11/2023
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