Mariel Lakeitha Clark, PSY.D.
Individual provider Active NPI Psychologist · Ozark, AL
NPI 1013343607 · NPPES record last updated Sep 16, 2013
Key facts
- NPI
- 1013343607
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychologist 103T00000X
- License
- 1838 (AL)
- Practice address
- 191 Katherine Ave
Ozark, AL 36360-1976 - Phone
- (334) 774-7704
- Fax
- (334) 774-7704
- NPI assigned
- Sep 16, 2013
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 1838 | AL | Yes |
Addresses
Primary practice location
191 Katherine Ave
Ozark, AL 36360-1976
Mailing address
191 Katherine Ave
Ozark, AL 36360-1976
Phone (334) 774-7704
Other providers in Ozark, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 16, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.