Individual
CLARK RANDALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
748 14TH AVE, LONGVIEW, WA 98632-2315
(360) 200-5419
Mailing address
748 14TH AVE, LONGVIEW, WA 98632-2315
(360) 200-5419
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
CG61088625
WA
Other
Enumeration date
07/10/2020
Last updated
07/10/2020
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