Organization
LEONARD A CLARK LCSW PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LARISA YASHCHENKO (AUTHORIZED REPRESENTATIVE)
(502) 509-6679
Entity
Organization
Contact information
Practice address
200 W LOWRY LN, LEXINGTON, KY 40503-3019
(859) 229-8160
(859) 276-5206
Mailing address
200 W LOWRY LN, LEXINGTON, KY 40503-3019
(859) 229-8160
(859) 276-5206
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1215085600
NPI
KY
Enumeration date
04/25/2019
Last updated
04/25/2019
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