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General NPI Number Information
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NPI Number | 1780571703
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Entity Type | Individual
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Provider Name | MR. SAMUEL S CLARK
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Gender | Male
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Dates
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Enumeration Date | 06/23/2025
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Last Update Date | 07/04/2025
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Provider Practice Location Address
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Address Line | 1511 WESTPORT RD
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City | KANSAS CITY
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State | MO
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Zip | 64111-4307
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Country | US
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Telephone | 913-349-1458
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Fax |
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Provider Business Mailing Address
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Address Line | 1942 STEWART AVE APT G20
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City | LAWRENCE
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State | KS
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Zip | 66046-2513
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Country | US
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Telephone | 785-410-4389
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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