Provider Demographics
NPI:1487048690
Name:CLARK, GARLAND BETHANY (MS CANDIDATE)
Entity type:Individual
Prefix:
First Name:GARLAND
Middle Name:BETHANY
Last Name:CLARK
Suffix:
Gender:F
Credentials:MS CANDIDATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5932 N MILTON ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205-7173
Mailing Address - Country:US
Mailing Address - Phone:609-290-7822
Mailing Address - Fax:
Practice Address - Street 1:5932 N MILTON ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-7173
Practice Address - Country:US
Practice Address - Phone:609-290-7822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-25
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACLARKGB108RC101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health