Provider Demographics
NPI:1255431185
Name:COWARD, CLINTON BUFORD (LCSW)
Entity type:Individual
Prefix:MR
First Name:CLINTON
Middle Name:BUFORD
Last Name:COWARD
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29300 GRANDVIEW LANE
Mailing Address - Street 2:
Mailing Address - City:PARKHILL
Mailing Address - State:OK
Mailing Address - Zip Code:74464
Mailing Address - Country:US
Mailing Address - Phone:918-683-3261
Mailing Address - Fax:918-680-3910
Practice Address - Street 1:1011 HONOR HEIGHTS DRIVE
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401
Practice Address - Country:US
Practice Address - Phone:918-683-3261
Practice Address - Fax:918-680-3910
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK27461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical