Provider Demographics
NPI:1215384938
Name:CLARK, JAYDE (LMFT)
Entity Type:Individual
Prefix:
First Name:JAYDE
Middle Name:
Last Name:CLARK
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8950 VILLA LA JOLLA DR STE C217
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1712
Mailing Address - Country:US
Mailing Address - Phone:855-427-2778
Mailing Address - Fax:858-638-8142
Practice Address - Street 1:8950 VILLA LA JOLLA DR STE C217
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1712
Practice Address - Country:US
Practice Address - Phone:855-427-2778
Practice Address - Fax:858-638-8142
Is Sole Proprietor?:No
Enumeration Date:2016-05-23
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist