Provider Demographics
NPI:1962865832
Name:WARNER, CLARK L (ACMHC)
Entity Type:Individual
Prefix:
First Name:CLARK
Middle Name:L
Last Name:WARNER
Suffix:
Gender:M
Credentials:ACMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5667 S REDWOOD RD
Mailing Address - Street 2:6B
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84123-5433
Mailing Address - Country:US
Mailing Address - Phone:801-529-6124
Mailing Address - Fax:801-905-1161
Practice Address - Street 1:5667 S REDWOOD RD
Practice Address - Street 2:6B
Practice Address - City:TAYLORSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84123-5433
Practice Address - Country:US
Practice Address - Phone:801-529-6124
Practice Address - Fax:801-905-1161
Is Sole Proprietor?:No
Enumeration Date:2016-03-30
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT101X00000X101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health