Provider Demographics
NPI:1497308118
Name:CLARKE, ANNE KATHLEEN (LPC)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:KATHLEEN
Last Name:CLARKE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 LEXINGTON AVE APT 1234
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-8376
Mailing Address - Country:US
Mailing Address - Phone:972-800-5694
Mailing Address - Fax:
Practice Address - Street 1:2701 SHORELINE DR
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210-0174
Practice Address - Country:US
Practice Address - Phone:940-222-2399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-22
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67748101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional