Individual
CARLA GAFF CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
EDD, HSPP
Contact information
Practice address
3111 W JACKSON ST, MUNCIE, IN 47304-4371
(765) 284-0879
(765) 284-1480
Mailing address
3111 W JACKSON ST, MUNCIE, IN 47304-4371
(765) 284-0879
(765) 284-1480
Taxonomy
Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
Primary
—
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000210033
ANTHEAM BCBS
IN
Enumeration date
08/17/2006
Last updated
07/26/2007
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