Provider Demographics
NPI:1790723179
Name:STAIGER, CLARK (LPC AND CEAP)
Entity Type:Individual
Prefix:
First Name:CLARK
Middle Name:
Last Name:STAIGER
Suffix:
Gender:M
Credentials:LPC AND CEAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 W CHERRY AVE
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73703-3318
Mailing Address - Country:US
Mailing Address - Phone:580-242-2829
Mailing Address - Fax:580-242-3888
Practice Address - Street 1:1021 W CHERRY AVE
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73703-3318
Practice Address - Country:US
Practice Address - Phone:580-242-2829
Practice Address - Fax:580-242-3888
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1759101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional