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General NPI Number Information
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NPI Number | 1306069521
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Entity Type | Individual
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Provider Name | CLARK PETER VOLKMANN LCPC
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Gender | Male
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Dates
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Enumeration Date | 04/10/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 912 MAIN AVE
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City | LIBBY
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State | MT
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Zip | 59923-1820
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Country | US
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Telephone | 406-293-4644
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Fax | 406-293-7644
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Provider Business Mailing Address
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Address Line | 421 MILNOR LAKE ROAD
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City | TROY
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State | MT
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Zip | 59935
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Country | US
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Telephone | 406-295-5442
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Fax | 406-295-9655
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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 | 279
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License Number State | MT
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