Individual
JACQUELYN J CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, CADC II, LPC
Contact information
Practice address
2577 NE COURTNEY DR, BEND, OR 97701-7638
(541) 322-7500
(541) 322-7565
Mailing address
2577 NE COURTNEY DR, BEND, OR 97701-7638
(541) 322-7500
(541) 322-7565
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
11-06-99
OR
101YP2500X
Professional Counselor
Primary
C2957
OR
Other
Enumeration date
02/02/2010
Last updated
09/13/2013
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