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Jacey Clark, CDPT
Counselor in Longview, Washington
NPI 1730676701

Jacey Clark is a Counselor based in Longview, WA. Jacey Clark practices in Longview, WA and has the professional credentials of CDPT. The NPI Number for Jacey Clark is 1730676701 and holds a License No. 60823909 (Washington).

The current practice location address for Jacey Clark is 720 14Th Avenue, Longview, WA and can be reached out via phone at 360-353-9840 and via fax at 360-353-9880. You can also correspond with Jacey Clark through the mailing address at 921 14TH AVENUE, LONGVIEW, WA - 98632 (mailing address contact number: 360-423-0203).

Location: 720 14Th Avenue, Longview, WA, 98632
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1730676701
Provider Name
Jacey Clark
Credential
CDPT
Provider Entity Type
Individual
Gender
Male
Address
720 14Th Avenue, Longview, WA, 98632
Phone Number
360-353-9840
Fax Number
360-353-9880
Provider Enumeration Date
04/16/2018
Last Update Date
03/10/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
2101625 05 WA
institution
Provider Business Practice Location Address Details
Address
720 14Th Avenue
City
Longview
State
Washington
Zip
98632
Phone Number
360-353-9840
Fax Number
360-353-9880
person
Provider Business Mailing Address Details
Address
720 14Th Avenue
City
Longview
State
Washington
Zip
98632
Phone Number
360-353-9840
Fax Number
360-353-9880
person
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
-
Taxonomy
101Y00000X
License No.
60823909 (Washington)
Definition
A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master's degree and clinical experience and supervision for licensure or certification.
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