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General NPI Number Information
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NPI Number | 1902404460
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Entity Type | Individual
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Provider Name | BRITTANY C CLARK
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Gender | Female
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Dates
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Enumeration Date | 10/15/2020
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Last Update Date | 03/15/2023
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Provider Practice Location Address
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Address Line | 3450 HIGHWAY 80 W
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City | JACKSON
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State | MS
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Zip | 39209-7201
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Country | US
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Telephone | 601-321-2400
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Fax |
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Provider Business Mailing Address
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Address Line | 107 GREENFIELD WAY
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City | MADISON
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State | MS
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Zip | 39110-8108
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Country | US
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Telephone | 601-479-8669
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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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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 2941
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License Number State | MS
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