Individual
MR. CLARK WILLIAM GUEST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LAADC #LNR2090411
Contact information
Practice address
9494 N GOVERNMENT WAY # 202, HAYDEN, ID 83835-9848
(208) 449-2509
Mailing address
212 W IRONWOOD DR # D-104, COEUR D ALENE, ID 83814-1403
(208) 449-2509
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
051235
CA
101YP2500X
Professional Counselor
Primary
7590
ID
106H00000X
Marriage & Family Therapist
—
—
Other
Enumeration date
05/23/2007
Last updated
05/16/2022
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