Provider Demographics
NPI:1588438287
Name:CLARK, LILLIAN VALE (PHD)
Entity type:Individual
Prefix:
First Name:LILLIAN
Middle Name:VALE
Last Name:CLARK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:LILLIAN
Other - Middle Name:VALE
Other - Last Name:HENDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:BUILDING 599 UNIVERSITY OF CALIFORNIA SANTA BARBARA
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93106-3979
Mailing Address - Country:US
Mailing Address - Phone:805-724-0449
Mailing Address - Fax:
Practice Address - Street 1:UC SANTA BARBARA CAPS BUILDING 599
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93106-0001
Practice Address - Country:US
Practice Address - Phone:805-893-4411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-13
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY34609103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling