Healthcare Provider Details

I. General information

NPI: 1730748799
Provider Name (Legal Business Name): D'LEXUS CLARK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2019
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 H ST SE
AUBURN WA
98002-6113
US

IV. Provider business mailing address

2100 24TH AVE S
SEATTLE WA
98144-4637
US

V. Phone/Fax

Practice location:
  • Phone: 206-334-8786
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: