Provider Demographics
NPI:1063458008
Name:CLEMENS, LAURIE PATRICE (PHD)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:PATRICE
Last Name:CLEMENS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 S LOWRY ST
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-3627
Mailing Address - Country:US
Mailing Address - Phone:405-612-0439
Mailing Address - Fax:405-533-1113
Practice Address - Street 1:619 S LOWRY ST
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-3627
Practice Address - Country:US
Practice Address - Phone:405-612-0439
Practice Address - Fax:405-533-1113
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-20
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK738103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical