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General NPI Number Information
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NPI Number | 1376197244
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Entity Type | Individual
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Provider Name | NEAL AARON CLARK LCSW
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Gender | Male
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Dates
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Enumeration Date | 07/30/2019
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Last Update Date | 03/30/2023
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Provider Practice Location Address
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Address Line | 4122 SHELBYVILLE RD STE 120
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City | LOUISVILLE
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State | KY
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Zip | 40207-3206
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Country | US
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Telephone | 502-289-6746
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Fax |
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Provider Business Mailing Address
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Address Line | 1038 FRONTIER TRL
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City | GREENVILLE
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State | IN
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Zip | 47124-8616
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Country | US
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Telephone | 502-356-9592
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 257398
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License Number State | KY
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