Provider Demographics
NPI:1376678441
Name:CLARK, JANIS S (MA, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:JANIS
Middle Name:S
Last Name:CLARK
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 LIGHTHOUSE AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-1764
Mailing Address - Country:US
Mailing Address - Phone:831-657-0777
Mailing Address - Fax:831-887-0216
Practice Address - Street 1:191 LIGHTHOUSE AVE APT 3
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-1764
Practice Address - Country:US
Practice Address - Phone:831-657-0777
Practice Address - Fax:831-887-0216
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20669106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist