Individual
JESSE WAYNE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPCC
Contact information
Practice address
65 GRADY CT, DAYTON, OH 45409
(937) 416-4031
Mailing address
5400 EDALBERT DR, CINCINNATI, OH 45239-7604
(937) 416-4031
(937) 534-1347
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
C.1200356
OH
101YM0800X
Mental Health Counselor
Primary
E.1600066
OH
101YP2500X
Professional Counselor
Primary
E.1600066
OH
Other
Enumeration date
10/24/2013
Last updated
02/24/2026
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