Individual
JAY K CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC, LPCC
Contact information
Practice address
115 5TH AVE S, SUITE 507, LA CROSSE, WI 54601-9200
(608) 797-5679
Mailing address
115 5TH AVE S, SUITE 507, LA CROSSE, WI 54601-9200
(608) 797-5679
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
3814-125
WI
101YP2500X
Professional Counselor
CC00106
MN
Other
Enumeration date
01/23/2008
Last updated
08/30/2013
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