Provider Demographics
NPI:1821815713
Name:JENNINGS-CLARK, LISA (MA)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:JENNINGS-CLARK
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34291 WAGON WHEEL TRL
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:CO
Mailing Address - Zip Code:80107-4105
Mailing Address - Country:US
Mailing Address - Phone:303-258-6881
Mailing Address - Fax:
Practice Address - Street 1:34291 WAGON WHEEL TRL
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:CO
Practice Address - Zip Code:80107-4105
Practice Address - Country:US
Practice Address - Phone:303-258-6881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral