Provider Demographics
NPI:1003111535
Name:CYNTHIA D. MCCLARENCE
Entity Type:Organization
Organization Name:CYNTHIA D. MCCLARENCE
Other - Org Name:CYNTHIA D. MCCLARENCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:MCCLARENCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-210-3993
Mailing Address - Street 1:4809 N DOUGLAS BLVD
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:OK
Mailing Address - Zip Code:73084-2306
Mailing Address - Country:US
Mailing Address - Phone:405-210-3993
Mailing Address - Fax:
Practice Address - Street 1:4809 N DOUGLAS BLVD
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:OK
Practice Address - Zip Code:73084-2306
Practice Address - Country:US
Practice Address - Phone:405-210-3993
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-13
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK22360251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management