Provider Demographics
NPI:1457410599
Name:CLARKE, MARILYN KAY (LCSW)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:KAY
Last Name:CLARKE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5321 S HARVARD AVE APT E
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-3865
Mailing Address - Country:US
Mailing Address - Phone:918-582-2131
Mailing Address - Fax:918-588-8822
Practice Address - Street 1:1620 E 12TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74120-5407
Practice Address - Country:US
Practice Address - Phone:918-582-2131
Practice Address - Fax:918-588-8822
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK21661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical