Individual
PHOEBE SAMANTHA CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, LPC, ATR.
Contact information
Practice address
19855 4TH ST STE 106, BEND, OR 97703-7814
(541) 203-0970
Mailing address
19855 4TH ST STE 106, BEND, OR 97703-7814
(541) 203-0970
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
C5258
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
85338559
—
NM
Enumeration date
01/12/2016
Last updated
04/30/2026
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