| Doctor Name: | JULIE ANNE CLARK |
| NPI Number: | 1316170038 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CDP |
| License Number: | CP00000788 |
| Business Practice Address: | 6808 220th St Sw Suite 204 Mountlake Terrace, WA - 980432187 |
| Business Phone Number: | 4254781000 |
| Business Fax Number: | 4256706578 |
| Mailing Address: | 6808 220th St Sw, Suite 204 MOUNTLAKE TERRACE |
| State: | WA |
| Postal Code: | 980432187 |
| Phone Number: | 4254781000 |
| Fax Number: | 4256706578 |
| NPI Enumeration Date: | 08/27/2009 |
| NPI Last Update Date: | 08/27/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | CP00000788 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |