Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | ||
Y | 101YP2500X | Professional Counselor | 4591 | TN |
NPI | 1003312497 |
---|---|
Provider Name | Aaron Brett Clark |
First Address | Knoxville, TN 37917-3120 |
Second Address | Knoxville, TN 37917-3120 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2018 |
Last Update Date | 10/11/2021 |