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General NPI Number Information
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NPI Number | 1427360296
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Entity Type | Individual
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Provider Name | TODD CLEVENGER LMSW
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Gender | Male
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Dates
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Enumeration Date | 07/09/2010
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Last Update Date | 06/02/2014
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Provider Practice Location Address
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Address Line | 4201 24TH AVE NW
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City | NORMAN
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State | OK
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Zip | 73069
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Country | US
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Telephone | 405-310-2794
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Fax |
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Provider Business Mailing Address
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Address Line | 2932 SW 126TH ST
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City | OKLAHOMA CITY
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State | OK
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Zip | 73170-2042
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Country | US
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Telephone | 316-461-6604
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 7776
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 4597
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License Number State | OK
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