Provider Demographics
NPI:1538356597
Name:CLARK, EMILY
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:CLARK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 901
Mailing Address - Street 2:
Mailing Address - City:BIGGS
Mailing Address - State:CA
Mailing Address - Zip Code:95917-0901
Mailing Address - Country:US
Mailing Address - Phone:415-601-8899
Mailing Address - Fax:530-868-1300
Practice Address - Street 1:750 N PALORA AVE
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-3627
Practice Address - Country:US
Practice Address - Phone:530-822-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-03
Last Update Date:2022-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical