Provider Demographics
NPI:1689723892
Name:CLARKE, MAIJA LEENA (PSYD)
Entity Type:Individual
Prefix:MISS
First Name:MAIJA
Middle Name:LEENA
Last Name:CLARKE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 AMBER WAY
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-1701
Mailing Address - Country:US
Mailing Address - Phone:530-899-8767
Mailing Address - Fax:530-879-3880
Practice Address - Street 1:630 SALEM ST
Practice Address - Street 2:STE 210
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928-5556
Practice Address - Country:US
Practice Address - Phone:530-519-4177
Practice Address - Fax:530-345-7677
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY19636103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical