Provider Demographics
NPI:1942365622
Name:CLARK, SHANA ELAINE (MA, LPC)
Entity Type:Individual
Prefix:MS
First Name:SHANA
Middle Name:ELAINE
Last Name:CLARK
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4219 RICHMOND AVE
Mailing Address - Street 2:STE. 219
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-6893
Mailing Address - Country:US
Mailing Address - Phone:713-627-7070
Mailing Address - Fax:713-627-9997
Practice Address - Street 1:4219 RICHMOND AVE
Practice Address - Street 2:STE. 219
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-6893
Practice Address - Country:US
Practice Address - Phone:713-627-7070
Practice Address - Fax:713-627-9997
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX09983101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional