Healthcare Provider Details

I. General information

NPI: 1568674943
Provider Name (Legal Business Name): TORI CLARK AMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TORI CLARK AMFT

II. Dates (important events)

Enumeration Date: 05/05/2007
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1807 BAILEY AVE
CHATTANOOGA TN
37404-3006
US

IV. Provider business mailing address

1807 BAILEY AVE
CHATTANOOGA TN
37404-3006
US

V. Phone/Fax

Practice location:
  • Phone: 423-414-4123
  • Fax:
Mailing address:
  • Phone: 423-414-4123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number3020
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: