Provider Demographics
NPI:1174625883
Name:CLARK, CHARLA HUGHES (MA, LMFT)
Entity type:Individual
Prefix:MS
First Name:CHARLA
Middle Name:HUGHES
Last Name:CLARK
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:MS
Other - First Name:CHARLA
Other - Middle Name:
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, LMFT
Mailing Address - Street 1:7822 NORTHWOODS DR
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-6429
Mailing Address - Country:US
Mailing Address - Phone:713-906-9930
Mailing Address - Fax:
Practice Address - Street 1:14780 MEMORIAL DR
Practice Address - Street 2:STE. 206
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-5284
Practice Address - Country:US
Practice Address - Phone:713-906-9930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5042101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health