Provider Demographics
NPI:1124101027
Name:HOUSE, CLARISSA ANN (LPC)
Entity type:Individual
Prefix:MRS
First Name:CLARISSA
Middle Name:ANN
Last Name:HOUSE
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 1:8229 CHUKAR RD
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-8447
Mailing Address - Country:US
Mailing Address - Phone:405-350-1143
Mailing Address - Fax:405-354-3718
Practice Address - Street 1:503 W VANDAMENT AVE
Practice Address - Street 2:SUITE A
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-4662
Practice Address - Country:US
Practice Address - Phone:405-265-1279
Practice Address - Fax:405-354-3718
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2058101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional