Individual
CHRISTOPHER CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
750 N FREEDOM BLVD, PROVO, UT 84601-1677
(801) 373-4760
(801) 373-0639
Mailing address
750 N FREEDOM BLVD, PROVO, UT 84601-1677
(801) 373-4760
(801) 373-0639
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
9903821-3501
UT
171M00000X
Case Manager/Care Coordinator
9903821-3503
UT
390200000X
Student in an Organized Health Care Education/Training Program
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—
Other
Enumeration date
08/12/2015
Last updated
04/04/2022
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