Individual
MR. CORY J CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC, LCDC, LMFTA
Contact information
Practice address
403 E 15TH ST, AUSTIN, TX 78701-1437
(512) 480-0920
Mailing address
1430 COLLIER ST, AUSTIN, TX 78704-2911
(512) 472-4357
(512) 703-1394
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
11614
TX
101YP2500X
Professional Counselor
Primary
67615
TX
Other
Enumeration date
04/09/2014
Last updated
04/09/2014
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