Provider Demographics
NPI:1326377417
Name:CLARK, NYCHELE THERESA (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:NYCHELE
Middle Name:THERESA
Last Name:CLARK
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:MS
Other - First Name:NYCHELE
Other - Middle Name:THERESA
Other - Last Name:BEAUREGARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:147 S ASHBURNHAM RD
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01473-1166
Mailing Address - Country:US
Mailing Address - Phone:508-450-9635
Mailing Address - Fax:
Practice Address - Street 1:71 MAIN ST
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01473-1472
Practice Address - Country:US
Practice Address - Phone:508-450-9635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-18
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7221101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health