MEDICARE: BRITTNEY CLARK LMHC

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	88000572A	IN

General Provider Information

NPI Number	:	1851971543
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRITTNEY CLARK LMHC

Provider Business Mailing Address
First Line	:	205 WAYNECROFT ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46241-1402
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	13965 N STATE ROAD 67
Second Line	:
City	:	CAMBY
State	:	IN
Zip	:	46113-8354
Country	:	US
Telephone Number	:	317-831-2686
Fax Number	:

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

Provider Enumeration Date	:	04/08/2021
Last Update Date	:	04/08/2021

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Directions to “ BRITTNEY CLARK LMHC” Practice Location

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