Provider Demographics
NPI:1851316632
Name:CLARK, NANCY J (MS)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:J
Last Name:CLARK
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3663 E SUNSET RD
Mailing Address - Street 2:STE 104
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120
Mailing Address - Country:US
Mailing Address - Phone:702-794-4409
Mailing Address - Fax:702-794-4501
Practice Address - Street 1:3663 E SUNSET RD
Practice Address - Street 2:STE 104
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120
Practice Address - Country:US
Practice Address - Phone:702-794-4409
Practice Address - Fax:702-794-4501
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVMFT0400106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist