Provider Demographics
NPI:1265782254
Name:CLARK, JAMIE M (LMHC, LCPC, SUDP)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:M
Last Name:CLARK
Suffix:
Gender:F
Credentials:LMHC, LCPC, SUDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1923 N LOCUST RD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VLY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-4149
Mailing Address - Country:US
Mailing Address - Phone:509-953-3692
Mailing Address - Fax:
Practice Address - Street 1:1923 N LOCUST RD
Practice Address - Street 2:
Practice Address - City:SPOKANE VLY
Practice Address - State:WA
Practice Address - Zip Code:99206-4149
Practice Address - Country:US
Practice Address - Phone:509-953-3692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-17
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP60777124101YA0400X
ID10339101YM0800X
WALH60625996101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)