Provider Demographics
NPI:1801241963
Name:CLARK, ERIN NICOLE (MSW)
Entity type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:NICOLE
Last Name:CLARK
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 N WILLSON AVE
Mailing Address - Street 2:SUITE 3005-10
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-3551
Mailing Address - Country:US
Mailing Address - Phone:406-595-3746
Mailing Address - Fax:
Practice Address - Street 1:300 N WILLSON AVE
Practice Address - Street 2:SUITE 3005-10
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-3551
Practice Address - Country:US
Practice Address - Phone:406-595-3746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-26
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-SWLC-LIC-167031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical