Individual
JEREMY KEITH CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1525 LINCOLN AVE, OGDEN, UT 84404-5638
(801) 621-6510
Mailing address
566 E 500 N, LOGAN, UT 84321-4251
(453) 938-8562
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
—
—
Other
Enumeration date
09/24/2020
Last updated
09/24/2020
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