Provider Demographics
NPI:1316210628
Name:CLARK, AURORA (EDS, LPC, NCC)
Entity Type:Individual
Prefix:MS
First Name:AURORA
Middle Name:
Last Name:CLARK
Suffix:
Gender:F
Credentials:EDS, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11559 NICHOLS WAY
Mailing Address - Street 2:
Mailing Address - City:CONIFER
Mailing Address - State:CO
Mailing Address - Zip Code:80433-7535
Mailing Address - Country:US
Mailing Address - Phone:732-859-7888
Mailing Address - Fax:
Practice Address - Street 1:11559 NICHOLS WAY
Practice Address - Street 2:
Practice Address - City:CONIFER
Practice Address - State:CO
Practice Address - Zip Code:80433-7535
Practice Address - Country:US
Practice Address - Phone:732-859-7888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-16
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00435600101YP2500X
COLPC.0016035101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty