Phillip J Clark | Olympia, WA • PECOS Search

Phillip J Clark

Counselor

Behavioral Health & Social Service Providers

206 Lilly Rd NE Apt B5, Olympia, WA 98506-5011

PECOS Enrollment

Based on the most recent information from CMS, provider Phillip J 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
1881838027
Provider Type
Individual
Full Name
Clark, Phillip J
Gender
Male

Sole Proprietor
No
Enumeration Date
4/30/2009
Last Updated
4/30/2009

Contact Information

Practice Location

206 Lilly Rd NE Apt B5, Olympia, WA 98506-5011

Unlisted Fax

Mailing Location

206 Lilly Rd NE Apt B5, Olympia, WA 98506-5011

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 101Y00000X Primary	Description Counselor Behavioral Health & Social Service Providers	License Unlisted Issuer