Healthcare Provider Details

I. General information

NPI: 1205320140
Provider Name (Legal Business Name): CLARISSA M FIFIELD LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2018
Last Update Date: 06/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1095 NICKERSON ST
WAYNOKA OK
73860-1252
US

IV. Provider business mailing address

1095 NICKERSON ST
WAYNOKA OK
73860-1252
US

V. Phone/Fax

Practice location:
  • Phone: 580-824-0674
  • Fax: 580-824-0676
Mailing address:
  • Phone: 580-824-0674
  • Fax: 580-824-0676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5433
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: