Individual
TYLEE COOPER CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2301 COVE AVE, LA GRANDE, OR 97850-3906
(541) 962-8800
(541) 963-5272
Mailing address
2301 COVE AVE, LA GRANDE, OR 97850-3906
(541) 962-8800
(541) 963-5272
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
1041C0700X
Clinical Social Worker
A15351
OR
Other
Enumeration date
09/15/2020
Last updated
12/01/2025
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