Provider Demographics
NPI:1376384230
Name:CLARK, TAMMY LYNN (MA, LPC)
Entity type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:LYNN
Last Name:CLARK
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:407 OAKLEAF DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-2927
Mailing Address - Country:US
Mailing Address - Phone:512-827-7607
Mailing Address - Fax:210-545-2504
Practice Address - Street 1:19115 FM 2252 STE 12
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78266-2578
Practice Address - Country:US
Practice Address - Phone:512-827-7607
Practice Address - Fax:210-545-2504
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-04
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX86990101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health