Provider Demographics
NPI:1326120262
Name:CLARK, RACHEL FRANCES (MS, MFT INTERN)
Entity Type:Individual
Prefix:MISS
First Name:RACHEL
Middle Name:FRANCES
Last Name:CLARK
Suffix:
Gender:F
Credentials:MS, MFT INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 15TH ST
Mailing Address - Street 2:#6
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-4257
Mailing Address - Country:US
Mailing Address - Phone:213-447-0755
Mailing Address - Fax:
Practice Address - Street 1:3100 S HARBOR BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-6823
Practice Address - Country:US
Practice Address - Phone:714-966-8694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 48452106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist