Provider Demographics
NPI:1093065237
Name:CLARK, WILLIAM PETER (LCSW)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:PETER
Last Name:CLARK
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 23RD ST
Mailing Address - Street 2:
Mailing Address - City:RAWLINS
Mailing Address - State:WY
Mailing Address - Zip Code:82301-5127
Mailing Address - Country:US
Mailing Address - Phone:307-324-8820
Mailing Address - Fax:307-333-0261
Practice Address - Street 1:606 23RD ST
Practice Address - Street 2:
Practice Address - City:RAWLINS
Practice Address - State:WY
Practice Address - Zip Code:82301-5127
Practice Address - Country:US
Practice Address - Phone:073-248-8203
Practice Address - Fax:307-333-0261
Is Sole Proprietor?:No
Enumeration Date:2012-09-14
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY6731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical