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General NPI Number Information
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NPI Number | 1790449445
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Entity Type | Individual
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Provider Name | THOMAS NATHAN CLARK LPC
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Gender | Male
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Dates
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Enumeration Date | 10/28/2021
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Last Update Date | 11/06/2025
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Provider Practice Location Address
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Address Line | 1010 W RALPH HALL PKWY STE 112
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City | ROCKWALL
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State | TX
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Zip | 75032-6690
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Country | US
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Telephone | 972-865-8782
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Fax | 972-499-6935
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Provider Business Mailing Address
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Address Line | PO BOX 93
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City | ROYSE CITY
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State | TX
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Zip | 75189-0093
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Country | US
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Telephone |
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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 | 82834
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License Number State | TX
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