Provider Demographics
NPI:1912877481
Name:CLARK COUNSELING SERVICES
Entity type:Organization
Organization Name:CLARK COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:M
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:256-850-4091
Mailing Address - Street 1:9869 PULASKI PIKE STE C
Mailing Address - Street 2:
Mailing Address - City:TONEY
Mailing Address - State:AL
Mailing Address - Zip Code:35773-7201
Mailing Address - Country:US
Mailing Address - Phone:256-850-4091
Mailing Address - Fax:256-970-1643
Practice Address - Street 1:9869 PULASKI PIKE STE C
Practice Address - Street 2:
Practice Address - City:TONEY
Practice Address - State:AL
Practice Address - Zip Code:35773-7201
Practice Address - Country:US
Practice Address - Phone:256-850-4091
Practice Address - Fax:256-970-1643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-11-10
Last Update Date:2025-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty