| NPI | 1487389250 |
|---|---|
| Professional Name | JACOB CLARK |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: VA 0701013896) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO 0022808) |
| Enumeration Date | 2022-07-18 |
| Last Update Date | 2025-09-09 |