| Doctor Name: | SHAY CLARK |
| NPI Number: | 1144569112 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | APC |
| License Number: | 80827886009 |
| Business Practice Address: | 1258 W South Jordan Pkwy South Jordan, UT - 840954711 |
| Business Phone Number: | 8012551155 |
| Business Fax Number: | |
| Mailing Address: | 350 Wood Dr, ALPINE |
| State: | UT |
| Postal Code: | 840042604 |
| Phone Number: | 8013727849 |
| Fax Number: | |
| NPI Enumeration Date: | 02/11/2013 |
| NPI Last Update Date: | 02/11/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 80827886009 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | UT |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |