Provider Demographics
NPI:1114235348
Name:CLEMONS, DANNY
Entity Type:Individual
Prefix:MR
First Name:DANNY
Middle Name:
Last Name:CLEMONS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12107 HERITAGE PARK RD
Mailing Address - Street 2:APT 236
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-9514
Mailing Address - Country:US
Mailing Address - Phone:662-292-3711
Mailing Address - Fax:
Practice Address - Street 1:12107 HERITAGE PARK RD
Practice Address - Street 2:APT 236
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-9514
Practice Address - Country:US
Practice Address - Phone:662-292-3711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-22
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor