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General NPI Number Information
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NPI Number | 1174886808
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Entity Type | Individual
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Provider Name | KORI CLARK
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Gender | Female
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Dates
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Enumeration Date | 06/18/2012
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Last Update Date | 01/06/2024
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Provider Practice Location Address
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Address Line | 1724 VINE ST
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City | DENVER
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State | CO
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Zip | 80206-1120
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Country | US
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Telephone | 503-997-0024
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Fax |
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Provider Business Mailing Address
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Address Line | 9374 ALANGO RD
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City | ANGORA
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State | MN
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Zip | 55703-4701
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Country | US
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Telephone |
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Fax |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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