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General NPI Number Information
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NPI Number | 1780884130
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Entity Type | Individual
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Provider Name | MARCY CLARK L.C.S.W.
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Gender | Female
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Dates
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Enumeration Date | 07/24/2007
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Last Update Date | 10/31/2016
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Provider Practice Location Address
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Address Line | 3200 AZALEA DR APT S5
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City | FORT COLLINS
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State | CO
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Zip | 80526-5719
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Country | US
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Telephone | 970-449-3132
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Fax |
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Provider Business Mailing Address
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Address Line | 3200 AZALEA DR., S5
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City | FORT COLLINS
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State | CO
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Zip | 80526
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Country | US
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Telephone | 970-449-3132
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW.09924235
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License Number State | CO
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