Individual
DESDA CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A., LPC
Contact information
Practice address
8129 NW WALNUT WAY, PARKVILLE, MO 64152-6103
(816) 510-6622
Mailing address
8129 NW WALNUT WAY, PARKVILLE, MO 64152-6103
(816) 510-6622
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
2008012808
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12132523
CAQH
—
Enumeration date
08/01/2010
Last updated
08/01/2010
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