| Doctor Name: | TERRI CLARK |
| NPI Number: | 1154576130 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MHPP |
| License Number: | |
| Business Practice Address: | 1704 Hwy 69 Trumann, AR - 72472 |
| Business Phone Number: | 8709336886 |
| Business Fax Number: | 8709339395 |
| Mailing Address: | 1815 Pleasant Grove Road, JONESBORO |
| State: | AR |
| Postal Code: | 72401 |
| Phone Number: | 8709336886 |
| Fax Number: | 8709339395 |
| NPI Enumeration Date: | 11/18/2008 |
| NPI Last Update Date: | 06/20/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |