Individual
MR. BARRY KENT CLARK JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LADC
Contact information
Practice address
100 W 7TH ST, OKMULGEE, OK 74447-5007
(918) 758-1910
(918) 756-1270
Mailing address
23625 LAMB TER, BROKEN ARROW, OK 74014-3062
(918) 357-3516
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
584
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
300522348
MEDICARE KOWETA GROUP
OK
Enumeration date
08/11/2006
Last updated
03/13/2009
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