Individual
MR. BRANDON W. CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
0309 2ND ST, LEWISTON, ID 83501-2163
(208) 717-4453
(855) 564-1778
Mailing address
2140 13TH ST, LEWISTON, ID 83501-3947
(208) 717-4453
(855) 564-1778
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW 35356
ID
1041C0700X
Clinical Social Worker
LW61085980
WA
Other
Enumeration date
03/25/2016
Last updated
10/14/2021
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