Individual
AVERY J CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
9201 OAKDALE AVE, CHATSWORTH, CA 91311-6542
(883) 227-3454
Mailing address
641 W 40TH PL APT 109B, LOS ANGELES, CA 90037-2066
(323) 670-8863
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
Y6738149
CA
Other
Enumeration date
07/17/2020
Last updated
07/17/2020
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