Tina Marie Clark, FSP

NPI #1871000877 in Idabel, Oklahoma

Provider Information

NPI Number: 1871000877
Entity Type: Individual
Name: Tina Marie Clark, FSP
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Peer Specialist
Credential: FSP
Enumeration Date: Dec 29, 2017
Last Updated: Dec 29, 2017

Practice Location

Address: 411 S CENTRAL AVE
City: Idabel
State: Oklahoma
ZIP Code: 74745-6059
Phone: (580) 286-5045

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Peer Specialist	175T00000X	Primary

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