| Doctor Name: | MS. MARY KATHERINE CLARK |
| NPI Number: | 1740689397 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | C0710221142 |
| Business Practice Address: | 1187 E South St Orland, CA - 959639136 |
| Business Phone Number: | 5308651146 |
| Business Fax Number: | 5308656483 |
| Mailing Address: | 1187 E South St, ORLAND |
| State: | CA |
| Postal Code: | 959639136 |
| Phone Number: | 5308651146 |
| Fax Number: | 5308656483 |
| NPI Enumeration Date: | 08/20/2014 |
| NPI Last Update Date: | 08/20/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | C0710221142 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |