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General NPI Number Information
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NPI Number | 1376384230
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Entity Type | Individual
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Provider Name | TAMMY LYNN CLARK M.A., LPC
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Gender | Female
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Dates
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Enumeration Date | 06/04/2024
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Last Update Date | 08/07/2024
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Provider Practice Location Address
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Address Line | 19115 FM 2252 STE 12
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City | SAN ANTONIO
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State | TX
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Zip | 78266-2578
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Country | US
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Telephone | 512-827-7607
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Fax | 210-545-2504
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Provider Business Mailing Address
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Address Line | 407 OAKLEAF DR
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City | SAN ANTONIO
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State | TX
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Zip | 78209-2927
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Country | US
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Telephone | 512-827-7607
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Fax | 210-545-2504
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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 | 86990
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License Number State | TX
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