Jerry Lee Clark M.H.S.

NPI 1356521371 - Counselor - 101Y00000X

NPI Details
NPI 1356521371
Gender Male
Enumeration Date 11/07/2007
Last Updated 11/07/2007
Entity Type Individual
Active Over 9 years ago
Practice Location
112 N BROAD ST
RM 821
PHILA PA, 19102-1510, US
Phone (215) 568-0860
Fax (215) 568-0769
Business Location
6913 LIMEKILN PIKE
PHILADELPHIA PA, 19138-2007, US
Phone (215) 548-1308
Fax
Toxanomy
Taxonomy Code 101Y00000X
License State
License Number
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According to our database, Mr. Jerry Lee Clark M.H.S. NPI is 1356521371, taxonomy code is 101Y00000X Jerry Lee Clark M.H.S. physically located at 112 N Broad St, Phila PA, 19102-1510. NPI Number Jerry Lee Clark M.H.S. has the Individual type.

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1356521371 NPI number is provided on an as is basis without warranty of any kind. 1356521371 is maintained by the National Plan & Provider Enumeration System. The contents of Jerry Lee Clark M.H.S. are for informational purposes only.