Provider Demographics
NPI:1003536632
Name:CLARK, AMY JENNINGS (LMHCA)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:JENNINGS
Last Name:CLARK
Suffix:
Gender:F
Credentials:LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1407 9TH AVE W APT E
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98119-3260
Mailing Address - Country:US
Mailing Address - Phone:206-450-4231
Mailing Address - Fax:
Practice Address - Street 1:1407 9TH AVE W APT E
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98119-3260
Practice Address - Country:US
Practice Address - Phone:206-450-4231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-01
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health