Gayle Clark, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

21245 Issued in OK

Practice address

6608 N Western Ave # 1728
Oklahoma City, OK 73116-7326

Phone

(616) 295-0048

NPI assigned

Dec 5, 2024

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Feb 11, 2025 through Feb 11, 2027

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• A Braver Space LLC

  • Community/Behavioral Health Agency
  • NPI 1194513960
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1733356800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1758499200000",
    "number": "1376359323",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6608 N WESTERN AVE # 1728",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731167326"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6608 N WESTERN AVE # 1728",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731167326",
            "telephone_number": "616-295-0048"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3003 E Michigan Ave # 1239",
            "address_purpose": "LOCATION",
            "city": "Lansing",
            "state": "MI",
            "postal_code": "489124616",
            "country_code": "US",
            "telephone_number": "405-774-9800",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "GAYLE",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-12-05",
        "last_updated": "2025-09-22",
        "certification_date": "2025-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OK",
            "license": "21245",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801119728",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christina Jane Clark, PA
• Debra Bynum Clark, ARNP
• Dori Clark, M.S. CCC-SLP
• Elizabeth Lynne Clark
• Emilyanne Clark
• Heidi Dawn Clark
• Jaci Clark, M.S., CCC-SLP
• James Clark, BHRS
• Joshua Daniel Clark
• Katelin Clark

• Clinical Social Worker in Oklahoma City, OK
• Providers in Oklahoma City, OK by specialty
• Clinical Social Worker in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.