Provider Demographics
NPI:1407133721
Name:JAMIE CLARK LCSW LLC
Entity Type:Organization
Organization Name:JAMIE CLARK LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:S
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:225-413-3922
Mailing Address - Street 1:13414 HOOPER RD # D
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70818-2909
Mailing Address - Country:US
Mailing Address - Phone:225-413-3922
Mailing Address - Fax:225-612-6551
Practice Address - Street 1:13414 HOOPER RD # D
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70818-2909
Practice Address - Country:US
Practice Address - Phone:225-413-3922
Practice Address - Fax:225-612-6551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-15
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA8738251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health