Individual
REBECCA ELIZABETH CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, LPCC
Contact information
Practice address
1751 SOUTHCROSS DR W, BURNSVILLE, MN 55306
(952) 892-7690
(952) 898-4930
Mailing address
12814 ECHO LN, APPLE VALLEY, MN 55124-8678
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
01481
MN
Other
Enumeration date
06/02/2018
Last updated
06/02/2018
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