Clark, Marylyn Ann

Clark, Marylyn Ann is an individual health care provider with primary practice located at 222 West Gurley St. Suite 105 , Prescott AZ 86301-3244. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), Behavioral Health & Social Service Providers / Marriage & Family Therapist. Behavioral Health & Social Service Providers / Marriage & Family Therapist is her primary health care specialty. Clark, Marylyn Ann can be contacted via phone (928) 778-1806.

Contact Information

Primary practice address
222 West Gurley St. Suite 105 Prescott AZ 86301-3244
Phone: (928) 778-1806
Fax: (928) 541-9308
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X LISAC11094 Arizona
Behavioral Health & Social Service Providers / Marriage & Family Therapist 106H00000X LMFT0053 Arizona

Profile Details

NPI number 1528114451
LBN Legal business name Clark, Marylyn Ann
Credentials PH D
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 25th, 2007
Last updated Jul 2nd, 2013 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1528114451 NPPES
Other EIN203600957 IRS

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