Provider Demographics
NPI:1982829388
Name:MCCLENDON, JANE K
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:K
Last Name:MCCLENDON
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:P O BOX 1739
Mailing Address - Street 2:
Mailing Address - City:GUYMON
Mailing Address - State:OK
Mailing Address - Zip Code:73942-1739
Mailing Address - Country:US
Mailing Address - Phone:580-338-7259
Mailing Address - Fax:580-338-2521
Practice Address - Street 1:1004 HWY 54 NE
Practice Address - Street 2:
Practice Address - City:GUYMON
Practice Address - State:OK
Practice Address - Zip Code:73942-1739
Practice Address - Country:US
Practice Address - Phone:580-338-7259
Practice Address - Fax:580-338-2521
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)