Provider Demographics
NPI:1679923445
Name:CLEMENT, OLIVIA (MHPP)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:CLEMENT
Suffix:
Gender:F
Credentials:MHPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11209 SW 39TH ST
Mailing Address - Street 2:
Mailing Address - City:MUSTANG
Mailing Address - State:OK
Mailing Address - Zip Code:73064-9274
Mailing Address - Country:US
Mailing Address - Phone:479-926-6405
Mailing Address - Fax:
Practice Address - Street 1:6710 NORTHWEST 43RD STREET
Practice Address - Street 2:
Practice Address - City:BETHANY
Practice Address - State:OK
Practice Address - Zip Code:73008
Practice Address - Country:US
Practice Address - Phone:405-717-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-13
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health