Provider Demographics
NPI:1487972444
Name:MCCLARTY, LUQUETTA DONYELLE (MHR)
Entity type:Individual
Prefix:MRS
First Name:LUQUETTA
Middle Name:DONYELLE
Last Name:MCCLARTY
Suffix:
Gender:F
Credentials:MHR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2513 SE 89TH TER
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-6067
Mailing Address - Country:US
Mailing Address - Phone:405-476-2945
Mailing Address - Fax:
Practice Address - Street 1:5710 E RENO AVE STE C
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-2005
Practice Address - Country:US
Practice Address - Phone:405-455-7244
Practice Address - Fax:405-455-7292
Is Sole Proprietor?:No
Enumeration Date:2010-05-13
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK461950908Medicaid