Individual
CHANELL CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MAS-MFT, LAMFT
Contact information
Practice address
1176 E WARNER RD STE 111, GILBERT, AZ 85296-3068
(480) 824-8458
Mailing address
13590 W CYPRESS ST, GOODYEAR, AZ 85395-2424
(602) 799-4385
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
10367
AZ
Other
Enumeration date
04/15/2018
Last updated
04/15/2018
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