Provider Demographics
NPI:1831507060
Name:CLARKE, CLYTEMNESTRA (LPC)
Entity type:Individual
Prefix:
First Name:CLYTEMNESTRA
Middle Name:
Last Name:CLARKE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6738 OHIO CANAL COURT
Mailing Address - Street 2:
Mailing Address - City:CANAL WINCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:43110-9076
Mailing Address - Country:US
Mailing Address - Phone:614-264-7211
Mailing Address - Fax:614-834-0488
Practice Address - Street 1:6738 OHIO CANAL COURT
Practice Address - Street 2:
Practice Address - City:CANAL WINCHESTER
Practice Address - State:OH
Practice Address - Zip Code:43110-9076
Practice Address - Country:US
Practice Address - Phone:614-264-7211
Practice Address - Fax:614-834-0488
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-31
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0600294101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional