Individual
TERYL L CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
789 BAMBERGER DR, SUITE A, AMERICAN FORK, UT 84003-2181
(801) 915-8792
Mailing address
13478 S LONE ROCK, DRAPER, UT 84020
(801) 915-8792
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
5970987-3501
UT
Other
Enumeration date
08/12/2013
Last updated
08/12/2013
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