Provider Demographics
NPI:1457370983
Name:CLARKSON, ANN (MFT)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:CLARKSON
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:
Other - Last Name:CLARKSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MFT
Mailing Address - Street 1:281 E H ST
Mailing Address - Street 2:
Mailing Address - City:BENICIA
Mailing Address - State:CA
Mailing Address - Zip Code:94510-3345
Mailing Address - Country:US
Mailing Address - Phone:707-746-7408
Mailing Address - Fax:707-745-6325
Practice Address - Street 1:281 E H ST
Practice Address - Street 2:
Practice Address - City:BENICIA
Practice Address - State:CA
Practice Address - Zip Code:94510-3345
Practice Address - Country:US
Practice Address - Phone:707-746-7408
Practice Address - Fax:707-745-6325
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38330106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist