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General NPI Number Information
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NPI Number | 1588850630
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Entity Type | Individual
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Provider Name | NISHANA R CLARKE M.S., MFT
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Gender | Female
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Dates
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Enumeration Date | 09/22/2007
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Last Update Date | 02/27/2024
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Provider Practice Location Address
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Address Line | 29995 TECHNOLOGY DR STE 103
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City | MURRIETA
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State | CA
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Zip | 92563-2633
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Country | US
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Telephone | 951-252-6083
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Fax | 951-800-8164
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Provider Business Mailing Address
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Address Line | PO BOX 696
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City | SUN CITY
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State | CA
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Zip | 92586-0696
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Country | US
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Telephone | 951-378-5233
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Fax | 951-800-8164
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFC 47887
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License Number State | CA
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