Provider Demographics
NPI:1740751106
Name:CLARK, BELINDA M (MA)
Entity Type:Individual
Prefix:
First Name:BELINDA
Middle Name:M
Last Name:CLARK
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 ALICE DR
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-1601
Mailing Address - Country:US
Mailing Address - Phone:618-622-3421
Mailing Address - Fax:
Practice Address - Street 1:126 ALICE DR
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-1601
Practice Address - Country:US
Practice Address - Phone:618-622-3421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-11
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health