Provider Demographics
NPI:1548432875
Name:CLARKE, NATASHA A
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:A
Last Name:CLARKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5701 GOLD POPPY WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95757-2824
Mailing Address - Country:US
Mailing Address - Phone:916-224-6900
Mailing Address - Fax:
Practice Address - Street 1:5701 GOLD POPPY WAY
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95757-2824
Practice Address - Country:US
Practice Address - Phone:916-224-6900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-27
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
CA52126106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor