Provider Demographics
NPI:1558866848
Name:CLARK, BARBARA JEAN (LPC)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:JEAN
Last Name:CLARK
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 1:1009 CIVIC ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-4101
Mailing Address - Country:US
Mailing Address - Phone:318-738-0750
Mailing Address - Fax:
Practice Address - Street 1:4396 HIGHWAY 80
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-8948
Practice Address - Country:US
Practice Address - Phone:318-251-4659
Practice Address - Fax:318-513-3612
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-28
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2920101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty