Provider Demographics
NPI:1104124593
Name:CLARK, JULEE P (MA , LMFT)
Entity type:Individual
Prefix:
First Name:JULEE
Middle Name:P
Last Name:CLARK
Suffix:
Gender:F
Credentials:MA , LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14806 ASHWORTH AVE N
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-6230
Mailing Address - Country:US
Mailing Address - Phone:206-362-9210
Mailing Address - Fax:
Practice Address - Street 1:1424 NE 155TH ST
Practice Address - Street 2:SUITE #204
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98155-7104
Practice Address - Country:US
Practice Address - Phone:206-362-9210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-09
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF00000952106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist