MEDICARE: SANNA J CLARK PLPC

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	:	1598239824
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANNA J CLARK PLPC

Provider Business Mailing Address
First Line	:	1303 S RIDGE DR
Second Line	:
City	:	MANDEVILLE
State	:	LA
Zip	:	70448-1021
Country	:	US
Telephone Number	:	985-502-1032
Fax Number	:

Provider Business Practice Location Address
First Line	:	4440 CANAL ST
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70119-5947
Country	:	US
Telephone Number	:	504-270-9618
Fax Number	:

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

Provider Enumeration Date	:	01/21/2019
Last Update Date	:	01/21/2019

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