Provider Demographics
NPI:1609822725
Name:COLLINS-CLARK, CYNTHIA LYNN (LPC)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:LYNN
Last Name:COLLINS-CLARK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 E 30TH ST
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-7950
Mailing Address - Country:US
Mailing Address - Phone:405-474-3467
Mailing Address - Fax:405-341-3467
Practice Address - Street 1:1616 E 19TH ST
Practice Address - Street 2:SUITE 404
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-6627
Practice Address - Country:US
Practice Address - Phone:405-474-3467
Practice Address - Fax:405-341-3467
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2218101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional