Provider Demographics
NPI:1326411950
Name:CLARK, SHERI LYN (PHD)
Entity Type:Individual
Prefix:DR
First Name:SHERI
Middle Name:LYN
Last Name:CLARK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 E MARSHALL AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-3110
Mailing Address - Country:US
Mailing Address - Phone:865-604-6772
Mailing Address - Fax:
Practice Address - Street 1:2525 E ARIZONA BILTMORE CIR STE D144
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-2105
Practice Address - Country:US
Practice Address - Phone:480-594-0422
Practice Address - Fax:855-915-0262
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-04
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3383103TC1900X
AZ4678103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling