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General NPI Number Information
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NPI Number | 1790240810
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Entity Type | Individual
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Provider Name | LATOYA D. CLARK M.A., LPC
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Gender | Female
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Dates
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Enumeration Date | 02/02/2019
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Last Update Date | 10/16/2024
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Provider Practice Location Address
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Address Line | 17510 HUFFMEISTER RD STE 102
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City | CYPRESS
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State | TX
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Zip | 77429-6785
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Country | US
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Telephone | 512-763-2186
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Fax |
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Provider Business Mailing Address
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Address Line | 14555 PHILIPPINE ST APT 1012
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City | HOUSTON
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State | TX
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Zip | 77040-7821
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Country | US
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Telephone | 832-561-0455
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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 | 77620
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License Number State | TX
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