Provider Demographics
NPI:1437439775
Name:CLARK, LYNNE MARIAN (MSW/LICSW/MFT)
Entity type:Individual
Prefix:
First Name:LYNNE
Middle Name:MARIAN
Last Name:CLARK
Suffix:
Gender:F
Credentials:MSW/LICSW/MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12714 W CRYSTAL LAKE DR
Mailing Address - Street 2:
Mailing Address - City:SUN CITY WEST
Mailing Address - State:AZ
Mailing Address - Zip Code:85375-2568
Mailing Address - Country:US
Mailing Address - Phone:208-770-0718
Mailing Address - Fax:
Practice Address - Street 1:12714 W CRYSTAL LAKE DR
Practice Address - Street 2:
Practice Address - City:SUN CITY WEST
Practice Address - State:AZ
Practice Address - Zip Code:85375-2568
Practice Address - Country:US
Practice Address - Phone:208-770-0718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-18
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-352431041C0700X, 1041C0700X
AZLCSW223331041C0700X
WASC601595041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical