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Connie Lynn Clark

Counselor

Behavioral Health & Social Service Providers

955 S Durkin Dr, Ste. B, Springfield, IL 62704-1370

PECOS Enrollment

Based on the most recent information from CMS, provider Connie Lynn Clark does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records yesterday at 12:57 PM.

Profile Details

Provider ID
1205913191
Provider Type
Individual
Full Name
Clark, Connie Lynn
Title
Ms.
Credential
M.S.ED., LCPC

Gender
Female
Sole Proprietor
Yes
Enumeration Date
11/1/2006
Last Updated
11/8/2008

Contact Information

Practice Location

955 S Durkin Dr, Ste. B, Springfield, IL 62704-1370

(217) 753-1288

Unlisted Fax

Mailing Location

955 S Durkin Dr, Ste. B, Springfield, IL 62704-1370

(217) 753-1288

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 101YP2500X Primary	Description Counselor Behavioral Health & Social Service Providers	License 180.006792 Illinois
Code 101YM0800X	Description Counselor Behavioral Health & Social Service Providers	License 180.006792 Illinois
Code 101Y00000X	Description Counselor Behavioral Health & Social Service Providers	License 180.006792 Illinois

Connie Lynn Clark

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

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Description

License

Code

Description

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Code

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