| Doctor Name: | LOUISA ANN CLARK |
| NPI Number: | 1184726895 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LMHC |
| License Number: | MH-4716 |
| Business Practice Address: | 430 Athens St Tarpon Springs, FL - 346893104 |
| Business Phone Number: | 7277098964 |
| Business Fax Number: | 3526109272 |
| Mailing Address: | Po Box 1996, TARPON SPRINGS |
| State: | FL |
| Postal Code: | 346881996 |
| Phone Number: | 7277098964 |
| Fax Number: | 3526109272 |
| NPI Enumeration Date: | 09/02/2006 |
| NPI Last Update Date: | 11/17/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | MH-4716 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |