Individual
TERRY CLARKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCDC
Contact information
Practice address
1110 W WILLIAM CANNON DR STE 303, AUSTIN, TX 78745-3188
(512) 899-2100
(512) 899-2205
Mailing address
3300 PARKER LN APT 266, AUSTIN, TX 78741-6972
(325) 763-8994
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
15547
TX
Other
Enumeration date
03/17/2022
Last updated
03/17/2022
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