Tina Michelle Clark

NPI #1104030899 in Chehalis, Washington

Provider Information

NPI Number: 1104030899
Entity Type: Individual
Name: Tina Michelle Clark
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Counselor - Mental Health
Enumeration Date: May 10, 2007
Last Updated: Jul 8, 2007

Practice Location

Address: 135 W MAIN ST
City: Chehalis
State: Washington
ZIP Code: 98532-4817
Phone: (360) 748-6696

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Counselor - Mental Health — Mental Health	101YM0800X	Primary

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