Individual
BRADLEY CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA LPCC LADC
Contact information
Practice address
12814 LAKE BLVD, LINDSTROM, MN 55045-9345
(651) 755-4276
(888) 972-5307
Mailing address
PO BOX 974, LINDSTROM, MN 55045-0974
(651) 755-4276
(888) 972-5307
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
3068
MN
Other
Enumeration date
12/20/2021
Last updated
12/20/2021
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