Individual
KELLEE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2222 N NEVADA AVE, COLORADO SPRINGS, CO 80907-6819
(719) 555-5555
Mailing address
1942 BROADWAY STE 314C, BOULDER, CO 80302-5233
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
1041C0700X
Clinical Social Worker
—
CO
1041C0700X
Clinical Social Worker
Primary
—
VA
Other
Enumeration date
02/04/2021
Last updated
01/06/2025
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