Provider Demographics
NPI:1316246283
Name:CLARK, NORMA GAIL (MA, LPC)
Entity type:Individual
Prefix:MS
First Name:NORMA
Middle Name:GAIL
Last Name:CLARK
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:261 PRIVATE ROAD 6059
Mailing Address - Street 2:
Mailing Address - City:WIERGATE
Mailing Address - State:TX
Mailing Address - Zip Code:75977-9792
Mailing Address - Country:US
Mailing Address - Phone:409-790-9989
Mailing Address - Fax:
Practice Address - Street 1:261 PRIVATE ROAD 6059
Practice Address - Street 2:
Practice Address - City:WIERGATE
Practice Address - State:TX
Practice Address - Zip Code:75977-9792
Practice Address - Country:US
Practice Address - Phone:409-790-9989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-17
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7442101YP2500X
TX65204101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional