MEDICARE: DANA MARIE CLARK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	APCC21107	CA

General Provider Information

NPI Number	:	1316877954
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANA MARIE CLARK

Provider Business Mailing Address
First Line	:	3433 W SHAW AVE STE 102
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93711-3229
Country	:	US
Telephone Number	:	559-374-3990
Fax Number	:

Provider Business Practice Location Address
First Line	:	3433 W SHAW AVE STE 102
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93711-3229
Country	:	US
Telephone Number	:	559-374-3990
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2026
Last Update Date	:	05/27/2026

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Directions to “ DANA MARIE CLARK ” Practice Location

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