Healthcare Provider Details

I. General information

NPI: 1316877954
Provider Name (Legal Business Name): DANA M CLARK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

670 E PINEDALE AVE
FRESNO CA
93720-3012
US

IV. Provider business mailing address

670 E PINEDALE AVE
FRESNO CA
93720-3012
US

V. Phone/Fax

Practice location:
  • Phone: 559-283-7918
  • Fax:
Mailing address:
  • Phone: 559-283-7918
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPCC21107
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: