Barry Kent Clark Jr., LADC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

584 Issued in OK

Practice address

100 W 7TH St
Okmulgee, OK 74447-5007

Phone

(918) 758-1910

Fax

(918) 756-1270

NPI assigned

Aug 11, 2006

Last updated

Mar 13, 2009By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1155254400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1236902400000",
    "number": "1962413070",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23625 LAMB TER",
            "city": "BROKEN ARROW",
            "state": "OK",
            "postal_code": "740143062",
            "telephone_number": "918-357-3516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 W 7TH ST",
            "city": "OKMULGEE",
            "state": "OK",
            "postal_code": "744475007",
            "telephone_number": "918-758-1910",
            "fax_number": "918-756-1270"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "BARRY",
        "middle_name": "KENT",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "LADC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-11",
        "last_updated": "2009-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OK",
            "license": "584",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE KOWETA GROUP",
            "identifier": "300522348",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Krista Charbonneau
• Darla Jo Cheatwood, RN, BSN
• Zachary Checotah
• Kyler Childress
• Tyson Au Christy, DDS
• Michelle L Clevenger
• Sebastian Cobelo
• Dorothy Diane Cockburn, C.P.N.P.
• Kristen Dyan Colbert
• Valerie L Collins

• Addiction (Substance Use Disorder) Counselor in Okmulgee, OK
• Providers in Okmulgee, OK by specialty
• Addiction (Substance Use Disorder) Counselor in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.