Individual
DR. KATHERINE TRAVIS CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
1016 INDUSTRIAL PARK DR, CLINTON, MS 39056-3210
(601) 383-2998
Mailing address
PO BOX 2332, CLINTON, MS 39060-2332
(601) 383-2998
(601) 924-7491
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
33-522
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04587367
—
MS
Enumeration date
10/12/2007
Last updated
10/12/2007
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