Provider Demographics
NPI:1497961262
Name:DOMECK, CLAIRE (MA/LMFT)
Entity Type:Individual
Prefix:MRS
First Name:CLAIRE
Middle Name:
Last Name:DOMECK
Suffix:
Gender:F
Credentials:MA/LMFT
Other - Prefix:
Other - First Name:CLARIVEL
Other - Middle Name:
Other - Last Name:SOTO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1950 N OKMULGEE
Mailing Address - Street 2:
Mailing Address - City:OKMULGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74447-6534
Mailing Address - Country:US
Mailing Address - Phone:918-756-7700
Mailing Address - Fax:918-756-3347
Practice Address - Street 1:1950 N OKMULGEE
Practice Address - Street 2:
Practice Address - City:OKMULGEE
Practice Address - State:OK
Practice Address - Zip Code:74447-6534
Practice Address - Country:US
Practice Address - Phone:918-756-7700
Practice Address - Fax:918-756-3347
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK811106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist