| Andrea Clark Psyd Llc | |
|
2401 Tee Cir Norman OK 73069-6207 | |
| (405) 801-2400 | |
| (405) 310-4052 |
| Full Name | Andrea Clark Psyd Llc |
|---|---|
| Speciality | Psychologist |
| Location | 2401 Tee Cir, Norman, Oklahoma |
| Authorized Official Name and Position | Andrea R Clark (PRESIDENT) |
| Authorized Official Contact | 4058012400 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Andrea Clark Psyd Llc 2401 Tee Cir Norman OK 73069-6207 Ph: (405) 801-2400 | Andrea Clark Psyd Llc 2401 Tee Cir Norman OK 73069-6207 Ph: (405) 801-2400 |
| NPI Number | 1861889818 |
|---|---|
| Provider Enumeration Date | 04/16/2015 |
| Last Update Date | 04/16/2015 |
| Medicare PECOS PAC ID | 2365763463 |
|---|---|
| Medicare Enrollment ID | O20150601002406 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861889818 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Andrea R Clark |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1912034596 PECOS PAC ID: 6305818071 Enrollment ID: I20040812000184 |
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