Doctor Name: | MS. JOAN MARIE CLARK |
NPI Number: | 1073531125 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | L.P.C. |
License Number: | 12842 |
Business Practice Address: | 2402 Broadmoor Dr 101-c Bryan, TX - 778022847 |
Business Phone Number: | 9797744134 |
Business Fax Number: | 9797764804 |
Mailing Address: | Po Box 826, MONTGOMERY |
State: | TX |
Postal Code: | 773560826 |
Phone Number: | 8887601996 |
Fax Number: | 9797764804 |
NPI Enumeration Date: | 07/17/2006 |
NPI Last Update Date: | 07/09/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 12842 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |