Individual
KELLY CLARKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
9901 W IH 10 STE 775, SAN ANTONIO, TX 78230-1781
(210) 957-1668
Mailing address
11511 WHISPER BREEZE ST, SAN ANTONIO, TX 78230-3524
(210) 268-4210
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
203074
TX
106H00000X
Marriage & Family Therapist
Primary
203074
TX
Other
Enumeration date
03/17/2020
Last updated
01/10/2024
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