| Doctor Name: | DR. JUDITH Z CLARK |
| NPI Number: | 1356440275 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PHD |
| License Number: | PSY13963 |
| Business Practice Address: | 126 Old Mammoth Rd Suite 214 Mammoth Lakes, CA - 93546 |
| Business Phone Number: | 7609248503 |
| Business Fax Number: | 7609240541 |
| Mailing Address: | Po 100 Pmb 470, MAMMOTH LAKES |
| State: | CA |
| Postal Code: | 935460100 |
| Phone Number: | 7609248503 |
| Fax Number: | 7609240541 |
| NPI Enumeration Date: | 09/21/2006 |
| NPI Last Update Date: | 09/20/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | PSY13963 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |