Individual
DR. SAMANTHA CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
144 E 14TH AVE STE B, EUGENE, OR 97401-3533
(252) 414-4163
Mailing address
617 S 41ST CT, SPRINGFIELD, OR 97478-7596
(252) 414-4163
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
103TC0700X
Clinical Psychologist
Primary
3811
OR
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/09/2022
Last updated
04/03/2024
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