Individual
MISS KELLY CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2301 E CHAMBERS DR, BOONEVILLE, MS 38829-8903
(662) 728-3154
Mailing address
2301 E CHAMBERS DR, BOONEVILLE, MS 38829-8903
(662) 728-3154
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
BS DEGREE
MS
Other
Enumeration date
11/04/2014
Last updated
11/04/2014
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