MEDICARE: ANGELICA CLAYTON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	XXX

General Provider Information

NPI Number	:	1205278975
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELICA CLAYTON

Provider Business Mailing Address
First Line	:	2045 W LINDSEY ST APT A
Second Line	:
City	:	NORMAN
State	:	OK
Zip	:	73069-4145
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2914 EPPERLY DR
Second Line	:
City	:	DEL CITY
State	:	OK
Zip	:	73115-3322
Country	:	US
Telephone Number	:	405-604-9790
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/23/2013
Last Update Date	:	07/23/2013

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Directions to “ ANGELICA CLAYTON ” Practice Location

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