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General NPI Number Information
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NPI Number | 1073531125
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Entity Type | Individual
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Provider Name | JOAN MARIE CLARK L.P.C.
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Gender | Female
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Dates
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Enumeration Date | 07/17/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 2402 BROADMOOR DR 101-C
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City | BRYAN
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State | TX
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Zip | 77802-2847
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Country | US
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Telephone | 979-774-4134
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Fax | 979-776-4804
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Provider Business Mailing Address
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Address Line | PO BOX 826
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City | MONTGOMERY
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State | TX
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Zip | 77356-0826
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Country | US
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Telephone | 888-760-1996
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Fax | 979-776-4804
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 12842
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License Number State | TX
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