Individual
KESSALYN RAE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW, LAC
Contact information
Practice address
501 EUCLID AVE, HELENA, MT 59601-2865
(406) 442-9244
Mailing address
400 HARRISON AVE, HELENA, MT 59601-6147
(406) 475-4684
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
BBH-LAC-LIC-31878
MT
101YP2500X
Professional Counselor
Primary
BBH-LCSW-LIC-55626
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
92-2641389
IRS
MT
Enumeration date
08/03/2018
Last updated
03/15/2023
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