Individual
JAYLA CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMCHA
Contact information
Practice address
54367 30TH ST STE 4, SOUTH BEND, IN 46635-2002
(574) 207-2026
Mailing address
54367 30TH ST STE 4, SOUTH BEND, IN 46635-2002
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
88002734A
IN
Other
Enumeration date
01/30/2025
Last updated
01/30/2025
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