Provider Demographics
NPI:1588850630
Name:CLARKE, NISHANA R (MS, MFT)
Entity Type:Individual
Prefix:MISS
First Name:NISHANA
Middle Name:R
Last Name:CLARKE
Suffix:
Gender:F
Credentials:MS, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 696
Mailing Address - Street 2:
Mailing Address - City:SUN CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92586-0696
Mailing Address - Country:US
Mailing Address - Phone:951-378-5233
Mailing Address - Fax:951-800-8164
Practice Address - Street 1:29995 TECHNOLOGY DR STE 103
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-2633
Practice Address - Country:US
Practice Address - Phone:951-252-6083
Practice Address - Fax:951-800-8164
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-22
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 47887106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist