Provider Demographics
NPI:1255702981
Name:SHOMO, CLARISSA
Entity type:Individual
Prefix:MRS
First Name:CLARISSA
Middle Name:
Last Name:SHOMO
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 1:210 E MAIN
Mailing Address - Street 2:RESOURCE MANAGEMENT
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820
Mailing Address - Country:US
Mailing Address - Phone:580-436-7211
Mailing Address - Fax:580-272-5757
Practice Address - Street 1:OUTPATIENT SERVICES PURCELL- 1726 N. GREEN AVE
Practice Address - Street 2:STRONG FAMILY DEVELOPMENT
Practice Address - City:PURCELL
Practice Address - State:OK
Practice Address - Zip Code:73080
Practice Address - Country:US
Practice Address - Phone:405-767-8940
Practice Address - Fax:405-767-8949
Is Sole Proprietor?:No
Enumeration Date:2015-10-07
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker