MEDICARE: TERRA CLARK LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1407404577
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERRA CLARK LPC

Provider Business Mailing Address
First Line	:	9434 SE GRACE CIR
Second Line	:
City	:	HAPPY VALLEY
State	:	OR
Zip	:	97086-5009
Country	:	US
Telephone Number	:	503-902-1157
Fax Number	:	971-318-0423

Provider Business Practice Location Address
First Line	:	9434 SE GRACE CIR
Second Line	:
City	:	HAPPY VALLEY
State	:	OR
Zip	:	97086-5009
Country	:	US
Telephone Number	:	503-902-1157
Fax Number	:	971-318-0423

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2019
Last Update Date	:	01/30/2026

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