Healthcare Provider Details

I. General information

NPI: 1992900591
Provider Name (Legal Business Name): MOLLY CLARK PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2007
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 ROBIN AVE STE 5
HAMMOND LA
70403-5773
US

IV. Provider business mailing address

15790 PAUL VEGA MD DR
HAMMOND LA
70403-1436
US

V. Phone/Fax

Practice location:
  • Phone: 985-230-5390
  • Fax: 985-230-5391
Mailing address:
  • Phone: 985-345-2700
  • Fax: 985-230-6652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number46810
License Number StateMS
# 3
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1794
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: