Provider Demographics
NPI:1053658534
Name:SANDERS, CLIFFORD DWAIN (LPC/LADC)
Entity type:Individual
Prefix:MR
First Name:CLIFFORD
Middle Name:DWAIN
Last Name:SANDERS
Suffix:
Gender:M
Credentials:LPC/LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24198 BRANGUS RD
Mailing Address - Street 2:
Mailing Address - City:TECUMSEH
Mailing Address - State:OK
Mailing Address - Zip Code:74873-7520
Mailing Address - Country:US
Mailing Address - Phone:405-598-1761
Mailing Address - Fax:
Practice Address - Street 1:214 E OAK AVE
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:OK
Practice Address - Zip Code:74868-3442
Practice Address - Country:US
Practice Address - Phone:405-382-1112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-03
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK798101YA0400X
OK2874101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)