Individual
BETHANEY CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
123 E POWELL BLVD STE 303, GRESHAM, OR 97030-7620
(971) 220-1495
Mailing address
4233 SE 182ND AVE # 212, GRESHAM, OR 97030-5082
(971) 220-1495
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
03/19/2019
Last updated
03/19/2019
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