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NPI Code Detail

MEDICARE: MS. CHERELYN CLARK M.A., MS.ED.

MEDICARE: MS. CHERELYN CLARK M.A., MS.ED.
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
1101YM0800XMental Health CounselorLH00011319WA

General Provider Information

NPI Number : 1659453397
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. CHERELYN CLARK M.A., MS.ED.
Provider Business Mailing Address
First Line : 6212 75TH ST W
Second Line : SUITE 1
City : LAKEWOOD
State : WA
Zip : 98499-8368
Country : US
Telephone Number : 253-208-1204
Fax Number : 253-584-2710
Provider Business Practice Location Address
First Line : 6212 75TH ST W
Second Line : SUITE 1
City : LAKEWOOD
State : WA
Zip : 98499-8368
Country : US
Telephone Number : 253-208-1204
Fax Number : 253-584-2710
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/20/2006
Last Update Date : 02/22/2011

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