Individual
DR. MOLLY CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 815-4778
(601) 984-5420
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 815-4778
(601) 984-5420
Taxonomy
Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
Primary
46810
MS
103TC1900X
Counseling Psychologist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01289231
—
MS
01
—
302I681423
MEDICARE PTAN
MS
Enumeration date
06/15/2007
Last updated
02/13/2014
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