MR. JERRY LEE CLARK M.H.S.
NPI 1356521371
Counselor in Phila, PA
- Individual
- Male
- Counselor
About JERRY CLARK
This page provides the complete NPI Profile along with additional information for Jerry Clark, a provider established in Phila, Pennsylvania with a medical specialization in Counselor. The healthcare provider is registered in the NPI registry with number 1356521371 assigned on November 2007. The practitioner's primary taxonomy code is 101Y00000X. The provider is registered as an individual and his NPI record was last updated 19 years ago.
- NPI
- 1356521371 Verify this NPI
- Provider Name
- MR. JERRY LEE CLARK M.H.S.
- Gender
- Male
- Entity Type
- Individual
- Location Address
- 112 N BROAD ST RM 821 PHILA, PA 19102
- Location Phone
- (215) 568-0860
- Location Fax
- (215) 568-0769
- Mailing Address
- 6913 LIMEKILN PIKE PHILADELPHIA, PA 19138
- Mailing Phone
- (215) 548-1308
- Is Sole Proprietor?
- No
- Enumeration Date
- 11-07-2007
- Last Update Date
- 11-07-2007
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Counselor
- Taxonomy Code
- 101Y00000X
- Type
- Behavioral Health & Social Service Providers
- Taxonomy Description
- A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master's degree and clinical experience and supervision for licensure or certification.
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Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1356521371, enumerated as an "individual" on November 07, 2007.
The provider is located at 112 N BROAD ST RM 821 PHILA, PA 19102 and the phone number is (215) 568-0860.
Counselor with taxonomy code 101Y00000X.
