Edna Clark, LPC

Individual provider Active NPI Mental Health Counselor · Marshall, TX

NPI 1295519353 · NPPES record last updated Aug 21, 2023

Key facts

NPI
1295519353
Entity type
Individual (NPI type 1)
Primary specialty
Mental Health Counselor 101YM0800X
License
6208 (TX)
Practice address
301 N Wellington St
Marshall, TX 75670-3335
Phone
(903) 938-4476
Fax
(903) 938-4125
NPI assigned
Aug 21, 2023
Sex
Female
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
6208TXMDMental Health Counselor

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor
Group: 193200000X MULTI-SPECIALTY GROUP
101YM0800X 6208 TX Yes

Addresses

Primary practice location

301 N Wellington St
Marshall, TX 75670-3335

Mailing address

PO Box 8317
Marshall, TX 75671-8317
Phone (903) 938-4476

Other providers in Marshall, TX

All providers in Marshall, TX · Mental Health Counselor in Texas

Sources for this page

Verify at the official NPI Registry.