Provider Demographics
NPI:1518394238
Name:CLARK, TORAYIA
Entity Type:Individual
Prefix:MRS
First Name:TORAYIA
Middle Name:
Last Name:CLARK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8808 LANSBROOK LN
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73132-2615
Mailing Address - Country:US
Mailing Address - Phone:405-361-2471
Mailing Address - Fax:
Practice Address - Street 1:7901 NE 10TH ST
Practice Address - Street 2:SUITE 8209
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-3600
Practice Address - Country:US
Practice Address - Phone:405-962-9191
Practice Address - Fax:866-422-5922
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-27
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200497040AMedicaid