Healthcare Provider Details

I. General information

NPI: 1467693762
Provider Name (Legal Business Name): MISTY DAWN CLOWER M.S. MH COUNSLING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISTY DAWN BLANKENSHIP BS

II. Dates (important events)

Enumeration Date: 03/16/2009
Last Update Date: 10/27/2022
Certification Date: 10/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 ROGERS DRIVE
HOLDENVILLE OK
74848-2877
US

IV. Provider business mailing address

1101 E MONROE AVE
MCALESTER OK
74501-4815
US

V. Phone/Fax

Practice location:
  • Phone: 405-379-6668
  • Fax:
Mailing address:
  • Phone: 918-426-7800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: