Basic Information
| Provider Information | |||||||||
| NPI: | 1669843041 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CLARK | ||||||||
| FirstName: | NATALIA | ||||||||
| MiddleName: | PATRICIA | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8300 US HIGHWAY 380 | ||||||||
| Address2: | |||||||||
| City: | CROSSROADS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 762272648 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9404370515 | ||||||||
| FaxNumber: | 9404638101 | ||||||||
| Practice Location | |||||||||
| Address1: | 1380 RIVER BEND DR | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752474914 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2147436146 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2015 | ||||||||
| LastUpdateDate: | 08/26/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 69323 | TX | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.