Provider Demographics
NPI:1619488350
Name:CLARK, CAROLINE JUNE (LMFT; LCPC; CRC)
Entity type:Individual
Prefix:MS
First Name:CAROLINE
Middle Name:JUNE
Last Name:CLARK
Suffix:
Gender:F
Credentials:LMFT; LCPC; CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:860 ZINNIA CIR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89015-2736
Mailing Address - Country:US
Mailing Address - Phone:702-566-3671
Mailing Address - Fax:
Practice Address - Street 1:1489 W WARM SPRINGS RD
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-7635
Practice Address - Country:US
Practice Address - Phone:702-373-3362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-20
Last Update Date:2017-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV01123106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist