Individual
MR. BRIAN R. CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
L.P.C.
Contact information
Practice address
623 W EASTERDAY AVE, SAULT SAINTE MARIE, MI 49783-1625
(906) 635-2752
Mailing address
2684 KAVANAUGH ST, OSSINEKE, MI 49766-9784
(989) 471-2205
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
6401000919
MI
104100000X
Social Worker
6801016728
MI
Other
Enumeration date
10/14/2008
Last updated
02/03/2016
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