Individual
TRACI B CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
110 LAKE POWELL DR, WEST MONROE, LA 71292-2107
(318) 614-4796
Mailing address
110 LAKE POWELL DR, WEST MONROE, LA 71292-2107
(318) 614-4796
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
4065
LA
Other
Enumeration date
09/17/2015
Last updated
09/17/2015
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