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1467679175
BRENDA GAYLE CLARK
WAGONER, OK
NPI
1467679175
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date
2007-04-20
Last Update Date
2007-07-08
Business Address
-- BRENDA GAYLE CLARK
109 S. HARRILL
WAGONER, OK 74467-5317
Phone number: 918-485-3554
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Mailing Address
-- BRENDA GAYLE CLARK
109 S. HARRILL
WAGONER, OK 74467-5317
Phone number: 918-485-3554
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