Clark, Susan
Clark, Susan is an individual health care provider with primary practice located at 1650 W Magnolia Ave 208, Ft Worth TX 76104-4009. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as her primary health care specialty. Clark, Susan can be contacted via phone (817) 912-8006.Contact Information
Primary practice address
1650 W Magnolia Ave 208
Ft Worth TX 76104-4009
Phone: (817) 912-8006
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Clinical | 1041C0700X | 50038 | Texas |
Profile Details
| NPI number | 1881754109 |
|---|---|
| LBN Legal business name | Clark, Susan |
| Credentials | LCSW-S |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Dec 8th, 2006 |
| Last updated | Dec 16th, 2022 - about 3 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1881754109 | NPPES |
| Texas | MEDICAID | 1881754109 |
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