Provider Demographics
NPI:1548597727
Name:CLARK, JANICE LAUREL (LMLP)
Entity Type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:LAUREL
Last Name:CLARK
Suffix:
Gender:F
Credentials:LMLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2208 BROMFIELD CIR
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-1105
Mailing Address - Country:US
Mailing Address - Phone:316-650-7221
Mailing Address - Fax:
Practice Address - Street 1:2208 BROMFIELD CIR
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-1105
Practice Address - Country:US
Practice Address - Phone:316-650-7221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-10
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLMLP 904101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health