MEDICARE: MRS. TORAYIA CLARK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518394238
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TORAYIA CLARK

Provider Business Mailing Address
First Line	:	8808 LANSBROOK LN
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73132-2615
Country	:	US
Telephone Number	:	405-361-2471
Fax Number	:

Provider Business Practice Location Address
First Line	:	7901 NE 10TH ST
Second Line	:	SUITE 8209
City	:	MIDWEST CITY
State	:	OK
Zip	:	73110-3600
Country	:	US
Telephone Number	:	405-962-9191
Fax Number	:	866-422-5922

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/27/2013
Last Update Date	:	09/27/2013

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