Individual
MARIE CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A., LMFT
Contact information
Practice address
141 MARKET PL, SUITE 206, FAIRVIEW HEIGHTS, IL 62208-2034
(314) 644-1557
(314) 453-4942
Mailing address
12685 DORSETT RD, #339, MARYLAND HEIGHTS, MO 63043-2100
(314) 644-1557
(314) 453-4942
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
166000714
IL
Other
Enumeration date
01/23/2012
Last updated
01/23/2012
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