Provider Demographics
NPI:1467592642
Name:CLAY CROSSING FOR WOMEN LLC
Entity Type:Organization
Organization Name:CLAY CROSSING FOR WOMEN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL/PROGRAM DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:CAROL
Authorized Official - Last Name:SIMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:MHR SUPERVISION
Authorized Official - Phone:405-527-2575
Mailing Address - Street 1:PO BOX 628
Mailing Address - Street 2:
Mailing Address - City:PURCELL
Mailing Address - State:OK
Mailing Address - Zip Code:73080-0628
Mailing Address - Country:US
Mailing Address - Phone:405-527-2575
Mailing Address - Fax:405-527-2863
Practice Address - Street 1:23899 STATE HIGHWAY 74
Practice Address - Street 2:
Practice Address - City:PURCELL
Practice Address - State:OK
Practice Address - Zip Code:73080-6964
Practice Address - Country:US
Practice Address - Phone:405-527-2575
Practice Address - Fax:405-527-2863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty