Individual
CLARK MAXON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
6180 LEHMAN DR, COLORADO SPRINGS, CO 80918-3444
(719) 492-6186
Mailing address
2325 DISTINCTIVE DR, COLORADO SPRINGS, CO 80920-3803
(719) 492-6186
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
08/07/2020
Last updated
08/07/2020
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