Provider Demographics
NPI:1912701632
Name:CLARK MENTAL HEALTH
Entity type:Organization
Organization Name:CLARK MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED COUNSELOR OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:BAYNE
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:615-719-3201
Mailing Address - Street 1:3413 RAINBOW PKWY STE A
Mailing Address - Street 2:
Mailing Address - City:RAINBOW CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35906-3234
Mailing Address - Country:US
Mailing Address - Phone:615-719-3201
Mailing Address - Fax:
Practice Address - Street 1:3413 RAINBOW PKWY STE A
Practice Address - Street 2:
Practice Address - City:RAINBOW CITY
Practice Address - State:AL
Practice Address - Zip Code:35906-3234
Practice Address - Country:US
Practice Address - Phone:615-719-3201
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-02
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty