Provider Demographics
NPI:1952651739
Name:CLARKE, JUSTIN ERIC (LMHC)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:ERIC
Last Name:CLARKE
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12038 12TH AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98168-2218
Mailing Address - Country:US
Mailing Address - Phone:425-224-6857
Mailing Address - Fax:
Practice Address - Street 1:12038 12TH AVE S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98168-2218
Practice Address - Country:US
Practice Address - Phone:425-224-6857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-19
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60570015101YM0800X
WACG60399285101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor