Provider Demographics
NPI:1659628493
Name:CLARK, JESSICA LC (LMHC, CCSOTS, TF-CBT)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LC
Last Name:CLARK
Suffix:
Gender:F
Credentials:LMHC, CCSOTS, TF-CBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:396 WASHINGTON ST # 266
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY HILLS
Mailing Address - State:MA
Mailing Address - Zip Code:02481-6209
Mailing Address - Country:US
Mailing Address - Phone:855-438-8331
Mailing Address - Fax:
Practice Address - Street 1:396 WASHINGTON ST # 266
Practice Address - Street 2:
Practice Address - City:WELLESLEY HILLS
Practice Address - State:MA
Practice Address - Zip Code:02481-6209
Practice Address - Country:US
Practice Address - Phone:855-438-8331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-11
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH 11318101YM0800X
101YM0800X
FL15397101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health