Provider Demographics
NPI:1073347928
Name:CLARK NOONAN MARRIAGE AND FAMILY COUNSELING A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:CLARK NOONAN MARRIAGE AND FAMILY COUNSELING A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CLARK
Authorized Official - Middle Name:
Authorized Official - Last Name:NOONAN
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:916-209-0352
Mailing Address - Street 1:5515 PACIFIC ST UNIT 141
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95677-4806
Mailing Address - Country:US
Mailing Address - Phone:916-209-0352
Mailing Address - Fax:
Practice Address - Street 1:1401 21ST ST # 5801
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95811-5226
Practice Address - Country:US
Practice Address - Phone:916-209-0352
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-30
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty