MEDICARE: ROBERT CLAYTON VANZANT MS

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	101Y00000X	Counselor	UNDER SUPERVISION
2	171M00000X	Case Manager/Care Coordinator	311838	OK
3	1041C0700X	Clinical Social Worker	8572-P	OK
4	251B00000X	Case Management Agency		OK

General Provider Information

NPI Number	:	1437360179
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT CLAYTON VANZANT MS

Provider Business Mailing Address
First Line	:	13900 COUNTRY ROAD 1554 DR LOT D4
Second Line	:
City	:	ADA
State	:	OK
Zip	:	74820-0898
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	225 E EVANS AVE
Second Line	:
City	:	SEMINOLE
State	:	OK
Zip	:	74868-3423
Country	:	US
Telephone Number	:	405-382-5438
Fax Number	:

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

Provider Enumeration Date	:	05/24/2007
Last Update Date	:	05/03/2023

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