Individual
KATHERINE DIANE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
400 W MIDLAND AVE, SUITE 202, WOODLAND PARK, CO 80863-3144
(719) 687-2880
(719) 686-0738
Mailing address
220 RUSKIN DR, COLORADO SPRINGS, CO 80910-2522
(719) 572-6150
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
1898
CO
163W00000X
Registered Nurse
91681
CO
Other
Enumeration date
05/29/2008
Last updated
05/29/2008
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