Provider Demographics
NPI:1922579440
Name:CLARK, PERRY DINARI (LMFT)
Entity Type:Individual
Prefix:MR
First Name:PERRY
Middle Name:DINARI
Last Name:CLARK
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2464 EL CAMINO REAL STE 121
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95051-3002
Mailing Address - Country:US
Mailing Address - Phone:408-890-7554
Mailing Address - Fax:
Practice Address - Street 1:2672 BAYSHORE PKWY STE 618
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94043-1017
Practice Address - Country:US
Practice Address - Phone:408-890-7554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-10
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA110594106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist