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General NPI Number Information
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NPI Number | 1821793258
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Entity Type | Individual
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Provider Name | MARY THERESA CLARK MA
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Gender | Female
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Dates
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Enumeration Date | 04/04/2023
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Last Update Date | 04/04/2023
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Provider Practice Location Address
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Address Line | 2264 BALTIMORE PIKE
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City | OXFORD
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State | PA
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Zip | 19363-4007
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Country | US
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Telephone | 610-932-0758
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Fax | 610-932-7744
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Provider Business Mailing Address
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Address Line | 133 E LOCUST ST APT 2
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City | OXFORD
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State | PA
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Zip | 19363-1305
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Country | US
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Telephone | 610-357-8698
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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