Provider Demographics
NPI:1437439775
Name:CLARK, LYNNE MARIAN (MSW/LICSW/MFT)
Entity Type:Individual
Prefix:
First Name:LYNNE
Middle Name:MARIAN
Last Name:CLARK
Suffix:
Gender:F
Credentials:MSW/LICSW/MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 421
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-0421
Mailing Address - Country:US
Mailing Address - Phone:509-474-6960
Mailing Address - Fax:509-227-7070
Practice Address - Street 1:105 W 8TH AVE STE 660E
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2302
Practice Address - Country:US
Practice Address - Phone:509-474-6960
Practice Address - Fax:509-227-7070
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-18
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW60217568104100000X, 1041C0700X
WASC601595041041C0700X
IDLCSW-352431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical