Provider Demographics
NPI:1366766883
Name:CLARK, HAROLD JEWETT JR (NMHC, ASSOC)
Entity type:Individual
Prefix:MR
First Name:HAROLD
Middle Name:JEWETT
Last Name:CLARK
Suffix:JR
Gender:M
Credentials:NMHC, ASSOC
Other - Prefix:
Other - First Name:JAY
Other - Middle Name:
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5801 23RD DR W
Mailing Address - Street 2:104
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98203-1587
Mailing Address - Country:US
Mailing Address - Phone:425-513-8213
Mailing Address - Fax:425-513-0534
Practice Address - Street 1:5801 23RD DR W
Practice Address - Street 2:104
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98203-1587
Practice Address - Country:US
Practice Address - Phone:425-513-8213
Practice Address - Fax:425-513-0534
Is Sole Proprietor?:No
Enumeration Date:2010-03-26
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor