Provider Demographics
NPI:1538190921
Name:CLANTON, MARC ANTHONY (PSYD)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:ANTHONY
Last Name:CLANTON
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N.E. 115 OLD TOWN ROAD
Mailing Address - Street 2:INDIAN HEALTH CENTER
Mailing Address - City:ANADARKO
Mailing Address - State:OK
Mailing Address - Zip Code:73005
Mailing Address - Country:US
Mailing Address - Phone:405-247-2458
Mailing Address - Fax:405-247-6653
Practice Address - Street 1:N.E. 115 OLD TOWN ROAD
Practice Address - Street 2:
Practice Address - City:ANADARKO
Practice Address - State:OK
Practice Address - Zip Code:73005
Practice Address - Country:US
Practice Address - Phone:405-247-2458
Practice Address - Fax:405-247-6653
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK870103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical