Provider Demographics
NPI:1932148129
Name:CLARK, COURTNEY LINSDALE (LCMFT)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:LINSDALE
Last Name:CLARK
Suffix:
Gender:F
Credentials:LCMFT
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:LINSDALE
Other - Last Name:DUNBAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:560 N EXPOSITION ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203-5957
Mailing Address - Country:US
Mailing Address - Phone:316-264-8317
Mailing Address - Fax:316-264-0347
Practice Address - Street 1:560 N EXPOSITION ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-5957
Practice Address - Country:US
Practice Address - Phone:316-264-8317
Practice Address - Fax:316-264-0347
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS328106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist