Individual
MR. GREGORY ALLEN CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1150 5TH ST STE 270, CORALVILLE, IA 52241-2933
(319) 804-9312
Mailing address
1150 5TH ST STE 270, CORALVILLE, IA 52241-2933
(319) 804-9312
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
093800
IA
Other
Enumeration date
10/16/2018
Last updated
10/16/2018
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