Provider Demographics
NPI:1235124983
Name:CLARK, BARBARA J (LMHC NCC)
Entity type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:J
Last Name:CLARK
Suffix:
Gender:F
Credentials:LMHC NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:365 ERICKSEN AVE NE
Mailing Address - Street 2:SUITE 311
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-1888
Mailing Address - Country:US
Mailing Address - Phone:206-842-4215
Mailing Address - Fax:206-842-2768
Practice Address - Street 1:365 ERICKSEN AVE NE
Practice Address - Street 2:SUITE 311
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-1888
Practice Address - Country:US
Practice Address - Phone:206-842-4215
Practice Address - Fax:206-842-2768
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00004988101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health