Individual ProviderAlthea ClarkCounselorBehavioral Health & Social Service ProvidersPractice Address600 S Tonopah Dr Ste 220, Las Vegas, NV 89106-4042(028) 249-6397(702) 824-9639PECOS EnrollmentBased on the most recent information from CMS, provider Althea Clark does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 4 days ago.Profile DetailsProvider ID1114322039Provider TypeIndividualFull NameClark, AltheaGenderFemaleSole ProprietorNoEnumeration Date11/4/2014Last Updated4/30/2021Contact InformationPractice LocationPractice Address600 S Tonopah Dr Ste 220, Las Vegas, NV 89106-4042Phone(028) 249-6397Fax(725) 214-3420Mailing LocationMailing Address600 S Tonopah Dr Ste 220, Las Vegas, NV 89106-4042Phone(702) 824-9639Fax(725) 214-3420Provider TaxonomiesCodeDescriptionLicenseCode101YM0800XPrimaryDescriptionCounselorBehavioral Health & Social Service ProvidersLicenseUnlisted Issuer