Individual
MRS. ANTOINETTE KELLY-CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
171 WATER TANK RD, RUSTON, LA 71270-8550
(318) 548-7242
Mailing address
171 WATER TANK RD, RUSTON, LA 71270-8550
(318) 548-7242
Taxonomy
Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
—
—
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
07/27/2023
Last updated
08/22/2024
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