Provider Demographics
NPI:1568778793
Name:CLARK, DAVID F (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:F
Last Name:CLARK
Suffix:
Gender:M
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:943 CENTAUR AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-0958
Mailing Address - Country:US
Mailing Address - Phone:702-991-3150
Mailing Address - Fax:866-658-4052
Practice Address - Street 1:2520 SAINT ROSE PKWY STE 108D
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-7784
Practice Address - Country:US
Practice Address - Phone:702-991-3150
Practice Address - Fax:866-658-4052
Is Sole Proprietor?:No
Enumeration Date:2010-08-25
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1421106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist