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General NPI Number Information
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NPI Number | 1063054310
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Entity Type | Organization
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Legal Business Name | CLARKE COUNSELING AND PSYCHOLOGICAL SERVICES
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Dates
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Enumeration Date | 10/08/2019
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Last Update Date | 11/08/2019
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Provider Practice Location Address
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Address Line | 710 OAKFIELD DR
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City | BRANDON
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State | FL
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Zip | 33511-4938
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Country | US
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Telephone | 813-445-8575
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Fax | 813-649-8085
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Provider Business Mailing Address
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Address Line | 710 OAKFIELD DR STE 153
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City | BRANDON
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State | FL
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Zip | 33511-4954
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Country | US
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Telephone | 813-445-8575
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Fax |
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Authorized Official
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Title or Position | PROVIDER
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Name | NICKEISHA K CLARKE
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Credential | PSYD
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Telephone | 813-445-8575
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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