Ebonye Patrice Clark

NPI #1962998062 in Midwest City, Oklahoma

Provider Information

NPI Number: 1962998062
Entity Type: Individual
Name: Ebonye Patrice Clark
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Peer Specialist
Enumeration Date: Jul 2, 2018
Last Updated: Jul 2, 2018

Practice Location

Address: 1704 CENTER DR APT 2
City: Midwest City
State: Oklahoma
ZIP Code: 73110-2869
Phone: (405) 679-7979

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Peer Specialist	175T00000X	Primary

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