Provider Demographics
NPI:1457864605
Name:CLARK, SEAN HOBAN
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:HOBAN
Last Name:CLARK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SEAN
Other - Middle Name:ELIZABETH
Other - Last Name:HOBAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2495 MAPLEWOOD DR STE 312
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109-1985
Mailing Address - Country:US
Mailing Address - Phone:651-760-3109
Mailing Address - Fax:651-967-9417
Practice Address - Street 1:2495 MAPLEWOOD DR STE 312
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-1985
Practice Address - Country:US
Practice Address - Phone:651-760-3109
Practice Address - Fax:651-967-9417
Is Sole Proprietor?:No
Enumeration Date:2017-11-09
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional