Most Relevant Information
Provider Data
| NPI Number: | 1003372269 |
| Provider Name: | SHELIA CLARK |
| Entity Type: | Individual |
| Taxonomy Code: | 101YM0800X |
| Specialty: | Counselor |
| License Number: |
Most Important Dates
| Enumeration Date: | 02/13/2019 |
| Last Updated: | 04/19/2021 |
Provider Practice Location
1103 NE ELM ST
PRINEVILLE
OR
977541664
Practice Location Phone/Fax
| Phone: | 5413235330 |
| Fax: | 5414471121 |
Provider Mailing Location
1103 NE ELM ST
PRINEVILLE
OR
977541664
Provider Mailing Phone/Fax
| Phone: | 5412333203 |
| Fax: | 5414471121 |