Provider Demographics
NPI:1962394759
Name:CLOTHER, CECIA
Entity type:Individual
Prefix:MS
First Name:CECIA
Middle Name:
Last Name:CLOTHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8906 E SKELLY DR STE J
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74129-3406
Mailing Address - Country:US
Mailing Address - Phone:786-710-8880
Mailing Address - Fax:
Practice Address - Street 1:8906 E SKELLY DR STE J
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74129-3406
Practice Address - Country:US
Practice Address - Phone:786-710-8880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-17
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLC436012977100171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator