Provider Demographics
NPI:1811056013
Name:CLARK, DEBORAH JEAN (LMSW,LMFT)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:JEAN
Last Name:CLARK
Suffix:
Gender:F
Credentials:LMSW,LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6301 GASTON AVE
Mailing Address - Street 2:STE 620
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214-3922
Mailing Address - Country:US
Mailing Address - Phone:214-370-5333
Mailing Address - Fax:214-370-5331
Practice Address - Street 1:6301 GASTON AVE
Practice Address - Street 2:STE 620
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75214-3922
Practice Address - Country:US
Practice Address - Phone:214-370-5333
Practice Address - Fax:214-370-5331
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX06855101YM0800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00P79POtherBCBS
TX0969135OtherAETNA
TX127007OtherVALUE OPTIONS