Individual
JASON CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
149 MERCY BLVD, MOUNT ORAB, OH 45154-0296
(119) 377-1231
Mailing address
149 MERCY BLVD, MOUNT ORAB, OH 45154-0296
(119) 377-1231
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
07/30/2021
Last updated
07/30/2021
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