Provider Demographics
NPI:1679041578
Name:CLARKE, JAMES LINCOLN JR (LMFT)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:LINCOLN
Last Name:CLARKE
Suffix:JR
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10063 RIVERSIDE DR
Mailing Address - Street 2:P.O. BOX 2041
Mailing Address - City:TOLUCA LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:91610
Mailing Address - Country:US
Mailing Address - Phone:323-407-8084
Mailing Address - Fax:
Practice Address - Street 1:5201 GREAT AMERICA PKWY
Practice Address - Street 2:STE 320 PMB236
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95054-1140
Practice Address - Country:US
Practice Address - Phone:323-407-8084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-08
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA137544106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist