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General NPI Number Information
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NPI Number | 1114254513
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Entity Type | Individual
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Provider Name | DAVID MCCLARTY JR. BHRS
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Gender | Male
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Dates
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Enumeration Date | 11/06/2009
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Last Update Date | 04/17/2014
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Provider Practice Location Address
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Address Line | 1212 S AIR DEPOT BLVD STE 19B
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City | MIDWEST CITY
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State | OK
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Zip | 73110-4830
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Country | US
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Telephone | 405-455-7244
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Fax | 405-455-9272
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Provider Business Mailing Address
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Address Line | 2513 SE 89TH TER
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City | MOORE
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State | OK
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Zip | 73160-6067
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Country | US
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Telephone | 405-410-8242
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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