Individual
ROGER BRENT CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ACMHC
Contact information
Practice address
440 N PAIUTE DR, CEDAR CITY, UT 84721-6181
(435) 586-1112
Mailing address
440 N PAIUTE DR, CEDAR CITY, UT 84721-6181
(435) 586-1112
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
11534461-6009
UT
Other
Enumeration date
03/18/2022
Last updated
03/18/2022
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