Provider Demographics
NPI:1053421289
Name:TURNER-CLARK, SUZETTE MARIE (LCSW)
Entity type:Individual
Prefix:MS
First Name:SUZETTE
Middle Name:MARIE
Last Name:TURNER-CLARK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11911 GARR AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-1322
Mailing Address - Country:US
Mailing Address - Phone:502-744-2070
Mailing Address - Fax:800-994-2153
Practice Address - Street 1:11405 PARK RD
Practice Address - Street 2:LOWER LEVEL-40
Practice Address - City:ANCHORAGE
Practice Address - State:KY
Practice Address - Zip Code:40223-2427
Practice Address - Country:US
Practice Address - Phone:502-744-2070
Practice Address - Fax:800-994-2153
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-17341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical