Provider Demographics
NPI:1568739282
Name:CLARK, ERIN MICHELLE (LPCC)
Entity Type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:MICHELLE
Last Name:CLARK
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 LEHMAN AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42103-6515
Mailing Address - Country:US
Mailing Address - Phone:270-393-9833
Mailing Address - Fax:270-393-9835
Practice Address - Street 1:1011 LEHMAN AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42103-6515
Practice Address - Country:US
Practice Address - Phone:270-393-9833
Practice Address - Fax:270-393-9835
Is Sole Proprietor?:No
Enumeration Date:2011-11-23
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0878101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health