Individual
TINA M CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LSCSW
Contact information
Practice address
7150 MILLBROOK ST, SHAWNEE, KS 66218-9235
(913) 522-8548
Mailing address
7150 MILLBROOK ST, SHAWNEE, KS 66218-9235
(913) 522-8548
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
3663
KS
Other
Enumeration date
10/12/2020
Last updated
10/12/2020
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