Provider Demographics
NPI:1568703742
Name:CLARK, LINDA GAYE
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:GAYE
Last Name:CLARK
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 1:148 S DOWLEN RD
Mailing Address - Street 2:# 638
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77707-1755
Mailing Address - Country:US
Mailing Address - Phone:409-782-5591
Mailing Address - Fax:
Practice Address - Street 1:148 S DOWLEN RD
Practice Address - Street 2:# 638
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77707-1755
Practice Address - Country:US
Practice Address - Phone:409-782-5591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-12
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX415271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical