Healthcare Provider Details

I. General information

NPI: 1982954368
Provider Name (Legal Business Name): TAMARA CLARK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2012
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 LEXINGTON ST TRLR 240
NORMAN OK
73069-8918
US

IV. Provider business mailing address

800 LEXINGTON ST TRLR 240
NORMAN OK
73069-8918
US

V. Phone/Fax

Practice location:
  • Phone: 405-406-0309
  • Fax:
Mailing address:
  • Phone: 405-406-0309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6436
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: