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LAVON JO CLARK
NPI 1568984060
Counselor - Mental Health in Miami, OK

Active since July 17, 2017PECOS Enrolled
111 S TREATY RD, MIAMI, OK 74354(918) 540-1511 Get Directions Write a Review

NPPES record last updated: July 21, 2022. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Jul 21, 2022, Jul 17, 2017 (2 updates tracked since 2017).

About Lavon Jo Clark NPPES

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

LAVON JO CLARK (NPI 1568984060) is an individual mental health provider in Miami, Oklahoma and active in the NPI registry since July 2017. She is enrolled in Medicare PECOS and is a graduate of Other (2017).

NPPES Registry Identity

NPI1568984060
Entity TypeIndividualFemale
Primary Taxonomy101YM0800X
Provider Legal NameLAVON JO CLARK
Location Address111 S TREATY RDMiami, OK 74354-5327
Mailing Address111 S Treaty RdMiami, OK 74354-5327 · (918) 540-1511
Phone(918) 540-1511
Sole ProprietorNo
Medical School CMSOtherGraduated 2017
Enumeration DateJuly 17, 2017
Last NPPES UpdateJuly 21, 20222 updates tracked since enumeration
✔ NPI 1568984060 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · Mental HealthBehavioral Health & Social Service Providers
Taxonomy Code101YM0800X
111 S TREATY RD, Miami, OK 74354
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Arkansas Health & Wellness, Ambetter from Sunflower Health Plan, Ambetter from Superior HealthPlan and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

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

PECOS PAC ID7911448113
PECOS Enrollment IDI20251026000013
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.

Medicare Billing Reassignments

2

Medicare enrollment records show Lavon Clark reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Creoks Mental Health Services
2.1 mi
Community/Behavioral Health
203 2ND AVE SW
Miami, OK 74354
  • Reassigned Medicare billing, Oklahoma enrollment
  • 77 clinicians in this Medicare group
NPI 1104360692 (918) 542-6412
Deer Oaks Mental Health Associates PC
747 mi
Clinical
3025 TERRACE DR
Las Cruces, NM 88011
  • Reassigned Medicare billing, Kansas enrollment
  • 21 clinicians in this Medicare group
NPI 1134175763 (888) 365-6271

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Other Providers at the Same Location NPPES 20

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

NINA SHORT
Peer Specialist
111 S TREATY RD
MIAMI, OK 74354
Ottawa County (918) 540-1511
JOHN KLENKE LPC-C
Counselor (Mental Health)
111 S TREATY RD
MIAMI, OK 74354
Ottawa County (918) 592-8614
BRANDON ALLAN MAPLES
Peer Specialist
111 S TREATY RD
MIAMI, OK 74354
Ottawa County (918) 540-1511
KASEY NICOLE KING
Case Manager/Care Coordinator
111 S TREATY RD
MIAMI, OK 74354
Ottawa County (918) 260-9546
CAROLINE JONES
Case Manager/Care Coordinator
111 S TREATY RD
MIAMI, OK 74354
Ottawa County (918) 540-1511
TIMOTHY HUNTER
Case Manager/Care Coordinator
111 S TREATY RD
MIAMI, OK 74354
Ottawa County (918) 540-1511
KAREN LEE FEATHER
Case Manager/Care Coordinator
111 S TREATY RD
MIAMI, OK 74354
Ottawa County (918) 540-1511
TERRY DEE ANN WILSON
Case Manager/Care Coordinator
111 S TREATY RD
MIAMI, OK 74354
Ottawa County (918) 540-1511

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 Lavon Clark's NPI number?

The NPI number for Lavon Clark is 1568984060. It was assigned to this individual provider in the NPPES registry on July 17, 2017.

Where is Lavon Clark located?

Lavon Clark practices at 111 S Treaty Rd, Miami, OK 74354. The listed phone number is (918) 540-1511.

What is Lavon Clark's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Mental Health, with taxonomy code 101YM0800X.

Is Lavon Clark enrolled in Medicare?

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

Which organizations bill Medicare for Lavon Clark's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Lavon Clark reassigns Medicare benefits to 2 organizations: Creoks Mental Health Services (Miami, OK) and Deer Oaks Mental Health Associates PC (Las Cruces, NM). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Lavon Clark's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Lavon Clark accept?

Health plans from Ambetter Health, Ambetter from Arkansas Health & Wellness, Ambetter from Sunflower Health Plan, Ambetter from Superior HealthPlan and Ambetter of Oklahoma and 4 other insurers list Lavon Clark as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Lavon Clark was last updated on July 21, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.