Individual
MRS. REBECCA CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
24401 W 39TH ST S, GODDARD, KS 67052-8713
(316) 794-2760
Mailing address
1981 N MCRAE CT, GODDARD, KS 67052-8579
(316) 347-5946
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
3044
KS
Other
Enumeration date
03/11/2017
Last updated
03/11/2017
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