Provider Demographics
NPI:1144657248
Name:CLARK, CHRISTOPHER ALEX (LMFT)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:ALEX
Last Name:CLARK
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 CORBITT DR
Mailing Address - Street 2:
Mailing Address - City:WILMORE
Mailing Address - State:KY
Mailing Address - Zip Code:40390-1096
Mailing Address - Country:US
Mailing Address - Phone:859-806-9813
Mailing Address - Fax:606-886-4433
Practice Address - Street 1:900 CORBITT DR
Practice Address - Street 2:
Practice Address - City:WILMORE
Practice Address - State:KY
Practice Address - Zip Code:40390-1096
Practice Address - Country:US
Practice Address - Phone:859-806-9813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-03
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY169304101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health