Provider Demographics
NPI:1407949977
Name:CLARK, MICHELLE J (NPP,LPC,LCPC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:J
Last Name:CLARK
Suffix:
Gender:F
Credentials:NPP,LPC,LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 BARCLAY DRIVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60139
Mailing Address - Country:US
Mailing Address - Phone:630-893-1238
Mailing Address - Fax:
Practice Address - Street 1:1120 RANDALL COURT
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134
Practice Address - Country:US
Practice Address - Phone:630-232-1070
Practice Address - Fax:630-232-1471
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional