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General NPI Number Information
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NPI Number | 1235669037
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Entity Type | Individual
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Provider Name | HENRY WILLIAM CLARK M.A., LPC
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Gender | Male
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Dates
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Enumeration Date | 06/14/2017
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Last Update Date | 12/18/2020
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Provider Practice Location Address
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Address Line | 409 VANDIVER WEST BLDG 6, SUITE 102A GREAT CIRCLE
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City | COLUMBIA
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State | MO
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Zip | 65202
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Country | US
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Telephone | 573-442-8331
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Fax |
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Provider Business Mailing Address
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Address Line | 1709 OAKWOOD CT
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City | COLUMBIA
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State | MO
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Zip | 65203-1704
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Country | US
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Telephone | 573-864-4600
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 002440
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License Number State | MO
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