Healthcare Provider Details

I. General information

NPI: 1790024594
Provider Name (Legal Business Name): CLARENCE YARHOLAR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2013
Last Update Date: 02/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105365 S. HWY 102 BLDG. H.
MCLOUD OK
74851-1059
US

IV. Provider business mailing address

PO BOX 1059
MCLOUD OK
74851-1059
US

V. Phone/Fax

Practice location:
  • Phone: 405-964-2618
  • Fax: 405-964-5677
Mailing address:
  • Phone: 405-964-2618
  • Fax: 405-964-5677

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: