MEDICARE: DANIELLE CLARK LPCC

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
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1821727827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLE CLARK LPCC

Provider Business Mailing Address
First Line	:	90 NORTHWOODS BLVD # B1-12
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43235-4719
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	90 NORTHWOODS BLVD # B1-12
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43235-4719
Country	:	US
Telephone Number	:	513-208-9495
Fax Number	:

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

Provider Enumeration Date	:	06/07/2022
Last Update Date	:	04/02/2024

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