Individual
CAMILLE CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
344 E 100 S, SALT LAKE CITY, UT 84111-1700
(801) 330-1864
Mailing address
344 E 100 S, SALT LAKE CITY, UT 84111-1700
(801) 330-1864
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
363735-6004
UT
Other
Enumeration date
04/02/2009
Last updated
08/19/2010
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