Individual provider · Type 1 NPI

Nicklaus Clark, LPC, LMHC

Professional Counselor · Gresham, OR

NPI number 1407251408 Active

Practice location

1700 NW Civic Dr, Suite 310
Gresham, OR 97030-3770

Call (503) 233-5405 Map

Mailing address

PO Box 82819
Portland, OR 97282-0819

Specialties and licenses

TaxonomyCodeLicense
Mental Health Counselor 101YM0800XLH60497951 (WA)
Professional Counselor Primary 101YP2500XC3550 (OR)
Professional Counselor 101YP2500X2012024654 (MO)

Professional Counselor: Definition to come...

12 other providers at this address

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About NPI 1407251408

Nicklaus Clark, LPC, LMHC's National Provider Identifier is 1407251408, issued on Nov 3, 2014. The primary taxonomy on file is Professional Counselor (101YP2500X), and the practice location is in Gresham, OR. The record was last updated on Feb 4, 2016.