Individual
BRADLEY W CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LSCSW, LCAC
Contact information
Practice address
9333 E 21ST ST N, WICHITA, KS 67206-2927
(316) 634-4700
(316) 634-4770
Mailing address
9333 E 21ST ST N, WICHITA, KS 67206-2927
(316) 634-4700
(316) 634-4770
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
10/14/2009
Last updated
10/22/2019
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