Healthcare Provider Details

I. General information

NPI: 1306213392
Provider Name (Legal Business Name): CAITLIN CLIFTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2015
Last Update Date: 08/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 N D ST
MCALESTER OK
74501-2314
US

IV. Provider business mailing address

127 CLIFTON RD
MCALESTER OK
74501-6394
US

V. Phone/Fax

Practice location:
  • Phone: 918-426-1614
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: