Julie D Clark, PHD

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

200 White Eagle Dr
Ponca City, OK 74601-8315

Phone

(580) 762-3421

NPI assigned

Nov 19, 2013

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Dr. Julie Diane Gallaher Clark Other name

Medicare fee-for-service enrollment

Enrolled in OK

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

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.

• White Eagle Health Center

  • Clinic/Center
  • Ponca City, OK
  • NPI 1699875724
  Medicare reassignment NPD
• White Eagle Health Center

  • Substance Abuse Rehabilitation Facility
  • Ponca City, OK
  • NPI 1265271910
  NPD

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

{
    "created_epoch": "1384819200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745020800000",
    "number": "1487084968",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1021",
            "city": "STILLWATER",
            "state": "OK",
            "postal_code": "740761021",
            "telephone_number": "405-269-6536"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 WHITE EAGLE DR",
            "city": "PONCA CITY",
            "state": "OK",
            "postal_code": "746018315",
            "telephone_number": "580-762-3421"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1011 Honor Heights Dr",
            "address_purpose": "LOCATION",
            "city": "Muskogee",
            "state": "OK",
            "postal_code": "744011318",
            "country_code": "US",
            "telephone_number": "918-577-3699",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "JULIE",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-11-19",
        "last_updated": "2025-04-19",
        "certification_date": "2025-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JULIE",
            "last_name": "CLARK",
            "middle_name": "DIANE GALLAHER",
            "prefix": "DR.",
            "credential": "PHD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Cimarron Valley Therapeutic Services, Inc.
• City of Ponca City
• Amanda Clark
• Caitlyn Clark
• Cody Wayne Clark
• Teresa Lynn Clay, RN
• Katie Clayton, SLPA125
• Francesca R Clifford, LPC
• Clinical Colleagues Inc
• Linda J Coats

• Mental Health Counselor in Ponca City, OK
• Providers in Ponca City, OK by specialty
• Mental Health Counselor in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.