Donna Clark | Victorville, CA • PECOS Search

Donna Clark

Marriage & Family Therapist

Behavioral Health & Social Service Providers

12625 Hesperia Rd, Victorville, CA 92395-7720

(760) 955-1777 (951) 704-8929

PECOS Enrollment

Based on the most recent information from CMS, provider Donna 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 2 days ago.

Profile Details

Provider ID
1639211949
Provider Type
Individual
Full Name
Clark, Donna
Gender
Female

Sole Proprietor
Yes
Enumeration Date
2/13/2007
Last Updated
9/9/2010

Contact Information

Practice Location

12625 Hesperia Rd, Victorville, CA 92395-7720

Unlisted Fax

Mailing Location

1269 Orange Ave, Beaumont, CA 92223-1707

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 106H00000X Primary	Description Marriage & Family Therapist Behavioral Health & Social Service Providers	License 40585 California