Provider Demographics
NPI:1295241586
Name:CLARK, BARRY SCOTT
Entity type:Individual
Prefix:MR
First Name:BARRY
Middle Name:SCOTT
Last Name:CLARK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROCKY
Mailing Address - State:OK
Mailing Address - Zip Code:73661-9000
Mailing Address - Country:US
Mailing Address - Phone:580-660-0088
Mailing Address - Fax:
Practice Address - Street 1:307 MAIN ST
Practice Address - Street 2:
Practice Address - City:ROCKY
Practice Address - State:OK
Practice Address - Zip Code:73661-9000
Practice Address - Country:US
Practice Address - Phone:580-660-0088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-21
Last Update Date:2017-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator