Provider Demographics
NPI:1750920773
Name:CLARK, KALEY MAE (MS LMHC)
Entity type:Individual
Prefix:
First Name:KALEY
Middle Name:MAE
Last Name:CLARK
Suffix:
Gender:F
Credentials:MS LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1608 LOMAS CIR
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC
Mailing Address - State:IA
Mailing Address - Zip Code:50022-2733
Mailing Address - Country:US
Mailing Address - Phone:712-249-2904
Mailing Address - Fax:
Practice Address - Street 1:514 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:ATLANTIC
Practice Address - State:IA
Practice Address - Zip Code:50022-1248
Practice Address - Country:US
Practice Address - Phone:712-249-2904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-23
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA095649101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health