| Doctor Name: | MRS. DEANNA CAROL CLARK |
| NPI Number: | 1013145093 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.A., MFT |
| License Number: | MFC39887 |
| Business Practice Address: | 911 E Colorado Blvd Ste 200 Pasadena, CA - 911061773 |
| Business Phone Number: | 8183191956 |
| Business Fax Number: | |
| Mailing Address: | 1052 W. Alameda Ave. Pmb 208, BURBANK |
| State: | CA |
| Postal Code: | 915062846 |
| Phone Number: | 8183191956 |
| Fax Number: | |
| NPI Enumeration Date: | 06/29/2009 |
| NPI Last Update Date: | 06/29/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | MFC39887 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |