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Individual
MR. THOMAS EDWARD CLARK
Active
Individual
MR. THOMAS EDWARD CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMFT, LMFT
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
56783
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
56783
MFT INTERN NUMBER
CA
Enumeration date
01/09/2009
Last updated
09/05/2014
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