Individual
JAY CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2101 ELM ST N, FARGO, ND 58102-2417
(701) 226-6796
Mailing address
7234 29TH ST S, FARGO, ND 58104
(701) 226-6796
Taxonomy
Speciality
Code
Description
License number
State
101YP1600X
Pastoral Counselor
Primary
—
—
101YP2500X
Professional Counselor
2479
NC
Other
Enumeration date
05/25/2023
Last updated
01/31/2024
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