Provider Demographics
NPI:1558409219
Name:ASHWORTH, CLARK D (PHD)
Entity Type:Individual
Prefix:DR
First Name:CLARK
Middle Name:D
Last Name:ASHWORTH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:358 E BIRCH AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:COLVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:99114-2762
Mailing Address - Country:US
Mailing Address - Phone:509-684-3200
Mailing Address - Fax:509-684-1908
Practice Address - Street 1:358 E BIRCH AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:COLVILLE
Practice Address - State:WA
Practice Address - Zip Code:99114-2762
Practice Address - Country:US
Practice Address - Phone:509-684-3200
Practice Address - Fax:509-684-1908
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1026103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA000304116Medicare ID - Type Unspecified