Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | LPC.0016653 | CO |
NPI | 1003384843 |
---|---|
Provider Name | Tomas Clarke |
First Address | Denver, CO 80224-1170 |
Second Address | Denver, CO 80211-4635 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2018 |
Last Update Date | 15/01/2021 |