Individual
RICHARD CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4611 S 96TH ST STE 222, OMAHA, NE 68127-1243
(402) 616-5139
Mailing address
2902 JACK PINE ST, BELLEVUE, NE 68123-5519
(402) 616-5139
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
1825
NE
Other
Enumeration date
08/20/2012
Last updated
08/04/2023
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