Provider Demographics
NPI:1811294176
Name:CLARK, KENDELL ELAINE (MS, LPC, NCC)
Entity type:Individual
Prefix:MS
First Name:KENDELL
Middle Name:ELAINE
Last Name:CLARK
Suffix:
Gender:F
Credentials:MS, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 SUNNYBROOK DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:OK
Mailing Address - Zip Code:73542-4013
Mailing Address - Country:US
Mailing Address - Phone:580-335-4860
Mailing Address - Fax:
Practice Address - Street 1:1118 NORTH 13TH STREET
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:OK
Practice Address - Zip Code:73542-1605
Practice Address - Country:US
Practice Address - Phone:580-335-4860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-23
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health