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General NPI Number Information
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NPI Number | 1356558381
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Entity Type | Individual
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Provider Name | BRENDA S. CLARK MS, LPCC, NCC
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Gender | Female
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4229 BARDSTOWN RD
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City | LOUISVILLE
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State | KY
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Zip | 40218-3241
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Country | US
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Telephone | 502-499-8010
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Fax |
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Provider Business Mailing Address
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Address Line | 1053 CHAPEL CREEK TRL
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City | NEW ALBANY
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State | IN
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Zip | 47150-9663
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Country | US
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Telephone | 812-246-0876
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Fax | 812-246-4108
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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 | 0541
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License Number State | KY
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