MEDICARE: CLARK MENTAL HEALTH

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	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1912701632
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLARK MENTAL HEALTH

Provider Business Mailing Address
First Line	:	3413 RAINBOW PKWY STE A
Second Line	:
City	:	RAINBOW CITY
State	:	AL
Zip	:	35906-3234
Country	:	US
Telephone Number	:	615-719-3201
Fax Number	:

Provider Business Practice Location Address
First Line	:	3413 RAINBOW PKWY STE A
Second Line	:
City	:	RAINBOW CITY
State	:	AL
Zip	:	35906-3234
Country	:	US
Telephone Number	:	615-719-3201
Fax Number	:

Authorized Official
Title or Position	:	LICENSED COUNSELOR OWNER
Name	:	LYNN BAYNE CLARK
Credential	:	LPC
Telephone Number	:	615-719-3201

Provider Enumeration Date	:	04/02/2025
Last Update Date	:	04/02/2025

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Directions to “CLARK MENTAL HEALTH ” Practice Location

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