Provider Demographics
NPI:1457653560
Name:KEAWPHALOUK, CLARA MAE (LPC CANDIDATE)
Entity Type:Individual
Prefix:
First Name:CLARA
Middle Name:MAE
Last Name:KEAWPHALOUK
Suffix:
Gender:F
Credentials:LPC CANDIDATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 885
Mailing Address - Street 2:1000 REID STREET
Mailing Address - City:SEMINOLE
Mailing Address - State:OK
Mailing Address - Zip Code:74818-0885
Mailing Address - Country:US
Mailing Address - Phone:405-585-7132
Mailing Address - Fax:
Practice Address - Street 1:1000 REID ST
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:OK
Practice Address - Zip Code:74868-2204
Practice Address - Country:US
Practice Address - Phone:405-585-7132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-22
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health