MEDICARE: VERONICA CLYBURN LPC-S

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	171M00000X	Case Manager/Care Coordinator		OK
2	101YM0800X	Mental Health Counselor	6921	OK

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	:	1841742327
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VERONICA CLYBURN LPC-S

Provider Business Mailing Address
First Line	:	9726 E 42ND ST STE 143
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74146-3626
Country	:	US
Telephone Number	:	918-859-5033
Fax Number	:

Provider Business Practice Location Address
First Line	:	9726 E 42ND ST STE 143
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74146-3626
Country	:	US
Telephone Number	:	918-859-5033
Fax Number	:

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

Provider Enumeration Date	:	10/31/2016
Last Update Date	:	08/20/2021

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