Individual
CAMILLE CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
8101 W HIGHWAY 71, AUSTIN, TX 78735-8103
(512) 537-9071
Mailing address
4701 STAGGERBRUSH RD APT 633, AUSTIN, TX 78749-1042
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
81367
TX
Other
Enumeration date
07/19/2019
Last updated
07/19/2019
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