Provider Demographics
NPI:1699834234
Name:CLARK, JO-ELLA
Entity Type:Individual
Prefix:
First Name:JO-ELLA
Middle Name:
Last Name:CLARK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9004 BELL BROOK LN
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923
Mailing Address - Country:US
Mailing Address - Phone:865-363-4133
Mailing Address - Fax:865-560-2580
Practice Address - Street 1:252 HARRY LANE BLVD STE 202
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4912
Practice Address - Country:US
Practice Address - Phone:865-338-5384
Practice Address - Fax:865-338-5383
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5326101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional