Provider Demographics
NPI:1578236519
Name:WEBB, CLARK LYLE (LMFT)
Entity type:Individual
Prefix:
First Name:CLARK
Middle Name:LYLE
Last Name:WEBB
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1575 OMAHA CT
Mailing Address - Street 2:
Mailing Address - City:DIXON
Mailing Address - State:CA
Mailing Address - Zip Code:95620-3862
Mailing Address - Country:US
Mailing Address - Phone:916-412-2732
Mailing Address - Fax:
Practice Address - Street 1:1575 OMAHA CT
Practice Address - Street 2:
Practice Address - City:DIXON
Practice Address - State:CA
Practice Address - Zip Code:95620-3862
Practice Address - Country:US
Practice Address - Phone:916-412-2732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-27
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA123255106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist