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BRENDA GAYLE CLARK
NPI 1467679175
Counselor - Addiction (Substance Use Disorder) in Wagoner, OK

Active since April 20, 2007PECOS Enrolled
109 S. HARRILL, WAGONER, OK 74467(918) 485-3554(918) 485-8371 Get Directions Write a Review

NPPES record last updated: July 8, 2007. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Brenda Gayle Clark NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

BRENDA GAYLE CLARK (NPI 1467679175) is an individual addiction (substance use disorder) provider in Wagoner, Oklahoma and active in the NPI registry since April 2007. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1467679175
Entity TypeIndividualFemale
Primary Taxonomy101YA0400X
Provider Legal NameBRENDA GAYLE CLARK
Location Address109 S. HARRILLWagoner, OK 74467-5317
Mailing Address109 S. HarrillWagoner, OK 74467-5317 · (918) 485-3554 · Fax (918) 485-8371
Phone(918) 485-3554
Fax(918) 485-8371
Sole ProprietorNo
Enumeration DateApril 20, 2007
Last NPPES UpdateJuly 8, 2007
✔ NPI 1467679175 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · Addiction (Substance Use Disorder)Behavioral Health & Social Service Providers
Taxonomy Code101YA0400X
109 S. HARRILL, Wagoner, OK 74467
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Brenda Gayle Clark is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MS. KATHY SUE MOBUS
Counselor
109 S. HARRILL
WAGONER, OK 74467
Wagoner County (918) 485-3554

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Brenda Clark's NPI number?

The NPI number for Brenda Clark is 1467679175. It was assigned to this individual provider in the NPPES registry on April 20, 2007.

Where is Brenda Clark located?

Brenda Clark practices at 109 S. Harrill, Wagoner, OK 74467. The listed phone number is (918) 485-3554.

What is Brenda Clark's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Addiction (Substance Use Disorder), with taxonomy code 101YA0400X.

Is Brenda Clark enrolled in Medicare?

Yes. Brenda Clark is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Brenda Clark was last updated on July 8, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.