Provider Demographics
NPI:1780165696
Name:CLARK, CRAIG STEVEN (MS, LPCC)
Entity type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:STEVEN
Last Name:CLARK
Suffix:
Gender:M
Credentials:MS, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 N ANKENY BLVD STE 113
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-4708
Mailing Address - Country:US
Mailing Address - Phone:612-437-1142
Mailing Address - Fax:515-289-9139
Practice Address - Street 1:2525 N ANKENY BLVD STE 113
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-4708
Practice Address - Country:US
Practice Address - Phone:515-289-9136
Practice Address - Fax:515-289-9139
Is Sole Proprietor?:No
Enumeration Date:2018-08-28
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA124790101YM0800X
MN1892101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional