| Doctor Name: | MR. PATRICK J. CLARK |
| NPI Number: | 1144292574 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MSW, LCSW |
| License Number: | 2003007957 |
| Business Practice Address: | 6055 Mexico Rd St Peters, MO - 633761632 |
| Business Phone Number: | 6364982273 |
| Business Fax Number: | 6364980390 |
| Mailing Address: | 9200 Watson Rd, Suite G101 SAINT LOUIS |
| State: | MO |
| Postal Code: | 631261528 |
| Phone Number: | 3143675500 |
| Fax Number: | 3148439212 |
| NPI Enumeration Date: | 02/01/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 2003007957 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |