Provider Demographics
NPI:1629287974
Name:CLARK, SHERRYL (LPC)
Entity Type:Individual
Prefix:
First Name:SHERRYL
Middle Name:
Last Name:CLARK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:SHERRYL
Other - Middle Name:
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1203 HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-2979
Mailing Address - Country:US
Mailing Address - Phone:817-874-8391
Mailing Address - Fax:
Practice Address - Street 1:1203 HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-2979
Practice Address - Country:US
Practice Address - Phone:817-874-8391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14558101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional