Individual
ELLEN CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S.
Contact information
Practice address
1430 OLIVE ST STE 400, SAINT LOUIS, MO 63103-2303
(314) 206-3700
Mailing address
1430 OLIVE ST STE 400, SAINT LOUIS, MO 63103-2303
(314) 206-3700
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
2021005152
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2021005152
LPC
MO
Enumeration date
01/10/2019
Last updated
03/30/2021
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