Provider Demographics
NPI:1700972783
Name:CLARKE, FRAN F (LCSW BCD)
Entity type:Individual
Prefix:MS
First Name:FRAN
Middle Name:F
Last Name:CLARKE
Suffix:
Gender:F
Credentials:LCSW BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116A FOREMAN DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506
Mailing Address - Country:US
Mailing Address - Phone:337-235-1261
Mailing Address - Fax:337-981-0211
Practice Address - Street 1:3 PEBBLESTONE DR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-4923
Practice Address - Country:US
Practice Address - Phone:337-235-1261
Practice Address - Fax:337-267-4448
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2716101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5T819Medicare ID - Type Unspecified