Individual
CAMILLIA CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COUI-9541
Contact information
Practice address
452 D ST, IDAHO FALLS, ID 83402-3531
(208) 552-0355
(208) 200-3201
Mailing address
452 D ST, IDAHO FALLS, ID 83402-3531
(208) 552-0355
(208) 200-3201
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
COUI-9541
ID
Other
Enumeration date
10/16/2023
Last updated
10/16/2023
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