Provider Demographics
NPI:1265581920
Name:PODREBARAC, CLARICE M (MS,LPC)
Entity type:Individual
Prefix:MS
First Name:CLARICE
Middle Name:M
Last Name:PODREBARAC
Suffix:
Gender:F
Credentials:MS,LPC
Other - Prefix:MRS
Other - First Name:CLARICE
Other - Middle Name:M
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS, MS
Mailing Address - Street 1:1000 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:EMPORIA
Mailing Address - State:KS
Mailing Address - Zip Code:66801-2449
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1000 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:EMPORIA
Practice Address - State:KS
Practice Address - Zip Code:66801-2449
Practice Address - Country:US
Practice Address - Phone:620-343-2211
Practice Address - Fax:620-342-1021
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS807101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health