Provider Demographics
NPI:1356186803
Name:CLARK, SHELDON DUNHAM (LPC-MHSP)
Entity type:Individual
Prefix:MR
First Name:SHELDON
Middle Name:DUNHAM
Last Name:CLARK
Suffix:
Gender:M
Credentials:LPC-MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5120 VIRGINIA WAY STE C-12
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-7515
Mailing Address - Country:US
Mailing Address - Phone:615-212-8614
Mailing Address - Fax:
Practice Address - Street 1:5120 VIRGINIA WAY STE C-12
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-7515
Practice Address - Country:US
Practice Address - Phone:615-212-8614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-26
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6655101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health