Provider Demographics
NPI:1346258316
Name:CLARK, PATRICIA PUSEY (MFT MARRIAGE AND FAM)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:PUSEY
Last Name:CLARK
Suffix:
Gender:F
Credentials:MFT MARRIAGE AND FAM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:659 CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404
Mailing Address - Country:US
Mailing Address - Phone:707-526-8300
Mailing Address - Fax:707-526-8310
Practice Address - Street 1:1330 N DUTTON
Practice Address - Street 2:S 100
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401
Practice Address - Country:US
Practice Address - Phone:707-526-8306
Practice Address - Fax:707-526-8319
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC33193106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist