Organization
RENAE CLARK-WEATHERLY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RENAE CLARK-WEATHERLY MA (THERAPIST)
(317) 222-9704
Entity
Organization
Contact information
Practice address
4126 E 10TH ST, INDIANAPOLIS, IN 46201-2613
(317) 686-0931
(866) 406-5077
Mailing address
5126 GUION RD, INDIANAPOLIS, IN 46254-1725
(317) 222-9704
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
99064493A
IN
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
99074128A
IN
Other
Enumeration date
10/05/2017
Last updated
09/01/2024
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