Provider Demographics
NPI:1740623305
Name:WOOD-CLARK, BRENDA L
Entity type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:L
Last Name:WOOD-CLARK
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:BRENDA
Other - Middle Name:L
Other - Last Name:WOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:2829 BUENA VISTA DR
Mailing Address - Street 2:
Mailing Address - City:CLIVE
Mailing Address - State:IA
Mailing Address - Zip Code:50325-4653
Mailing Address - Country:US
Mailing Address - Phone:641-745-0499
Mailing Address - Fax:515-987-2390
Practice Address - Street 1:699 WALNUT ST 4TH
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-3929
Practice Address - Country:US
Practice Address - Phone:641-745-0499
Practice Address - Fax:515-987-2390
Is Sole Proprietor?:No
Enumeration Date:2013-04-14
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001610101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health