Provider Demographics
NPI:1669849840
Name:CLARK, JO ELLEN N (LCSW)
Entity type:Individual
Prefix:
First Name:JO ELLEN
Middle Name:N
Last Name:CLARK
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 NISSEN RD UNIT 1
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-2268
Mailing Address - Country:US
Mailing Address - Phone:831-776-6375
Mailing Address - Fax:
Practice Address - Street 1:142 NISSEN RD UNIT 1
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-2268
Practice Address - Country:US
Practice Address - Phone:831-776-6375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-24
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1061611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical