=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316852577
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LIESL CLARK CMHC, NCC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/14/2026
-----------------------------------------------------
Last Update Date | 08/14/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 166 S RIVER RD STE 220
-----------------------------------------------------
City | BEDFORD
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03110-6928
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-836-4112
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 42 ROSE FARM RD
-----------------------------------------------------
City | LYNDEBOROUGH
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03082-6342
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-554-6343
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------