Provider Demographics
NPI:1396155230
Name:SPRINGWATER, CLIFFORD WRIGHT
Entity type:Individual
Prefix:MR
First Name:CLIFFORD
Middle Name:WRIGHT
Last Name:SPRINGWATER
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:C. W.
Other - Middle Name:
Other - Last Name:SPRINGWATER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:8151 HWY 177
Mailing Address - Street 2:
Mailing Address - City:RED ROCK
Mailing Address - State:OK
Mailing Address - Zip Code:74651
Mailing Address - Country:US
Mailing Address - Phone:580-723-4466
Mailing Address - Fax:580-723-1067
Practice Address - Street 1:8151 HWY 177
Practice Address - Street 2:
Practice Address - City:RED ROCK
Practice Address - State:OK
Practice Address - Zip Code:74651
Practice Address - Country:US
Practice Address - Phone:580-723-4466
Practice Address - Fax:580-723-1067
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-30
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)