Provider Demographics
NPI:1780754283
Name:CLIBURN, B. GALE (MHR, LPC)
Entity type:Individual
Prefix:MS
First Name:B.
Middle Name:GALE
Last Name:CLIBURN
Suffix:
Gender:F
Credentials:MHR, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5613
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73083-5613
Mailing Address - Country:US
Mailing Address - Phone:405-306-1883
Mailing Address - Fax:405-475-1721
Practice Address - Street 1:13810 CROSSING WAY E
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-4720
Practice Address - Country:US
Practice Address - Phone:405-306-1883
Practice Address - Fax:405-475-1721
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2473101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health