TINA MARIE CLARK FSP NPI 1871000877

NPI Information

NPI: 1871000877
Provider Name: TINA MARIE CLARK, FSP
Classification: Peer Specialist - 175T00000X
Entity Type: Individual
Address:
411 S CENTRAL AVE
IDABEL, OK
ZIP 74745
Phone: (580) 286-5045
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Tina Marie Clark, FSP is a peer specialist in Idabel, OK. The provider is individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority. Tina Marie Clark, FSP NPI is 1871000877. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

411 S CENTRAL AVE
IDABEL, OK
ZIP 74745-059
Phone: (580) 286-5045
Fax: (580) 286-5721

The enumeration date for this NPI number is 12/29/2017 and was last updated on 12/29/2017.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	175T00000X	Peer Specialist				Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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