| NPI | 1376263319 |
|---|---|
| Doing Business As | KELLI CLARK, LCSW, PC |
| Entity Type | Organization |
| Authorized Contact | JULIO LAGOS Operations 415-562-4156 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2022-08-30 |
| Last Update Date | 2022-08-30 |