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General NPI Number Information
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NPI Number | 1639869050
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Entity Type | Organization
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Legal Business Name | CLARK MENTAL HEALTH SERVICES
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Dates
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Enumeration Date | 05/09/2023
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Last Update Date | 05/09/2023
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Provider Practice Location Address
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Address Line | 1331 UNION AVE STE 1148
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City | MEMPHIS
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State | TN
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Zip | 38104-7509
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Country | US
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Telephone | 901-292-4407
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Fax |
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Provider Business Mailing Address
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Address Line | 1331 UNION AVE STE 1148
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City | MEMPHIS
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State | TN
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Zip | 38104-7509
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Country | US
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Telephone | 901-292-4407
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ZINA R CLARK
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Credential | APRN, PMHNP-BC
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Telephone | 901-292-4407
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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