Provider Demographics
NPI:1811376544
Name:NOLAN-CLACK, LEAH
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:NOLAN-CLACK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:177 SPRINGTREE PKWY
Mailing Address - Street 2:
Mailing Address - City:CIBOLO
Mailing Address - State:TX
Mailing Address - Zip Code:78108-3226
Mailing Address - Country:US
Mailing Address - Phone:830-362-4545
Mailing Address - Fax:210-545-7737
Practice Address - Street 1:12414 NACOGDOCHES RD STE 101A
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-2145
Practice Address - Country:US
Practice Address - Phone:830-362-4545
Practice Address - Fax:210-545-7737
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-27
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70290101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional