Provider Demographics
NPI:1689188914
Name:AUSLOOS, CLARK DAVID (MA, LPC, LPSC, NCC)
Entity Type:Individual
Prefix:MR
First Name:CLARK
Middle Name:DAVID
Last Name:AUSLOOS
Suffix:
Gender:M
Credentials:MA, LPC, LPSC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26863 CARRONADE DR APT 7201
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-6432
Mailing Address - Country:US
Mailing Address - Phone:920-948-2467
Mailing Address - Fax:
Practice Address - Street 1:830 W SOUTH BOUNDARY ST STE A
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-5238
Practice Address - Country:US
Practice Address - Phone:419-931-3020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-22
Last Update Date:2017-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1700624101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional