Provider Demographics
NPI:1679054498
Name:CLARK, KATE LYNN MATTHEWS (LCPC-C)
Entity type:Individual
Prefix:
First Name:KATE
Middle Name:LYNN MATTHEWS
Last Name:CLARK
Suffix:
Gender:F
Credentials:LCPC-C
Other - Prefix:
Other - First Name:KATE
Other - Middle Name:LYNN
Other - Last Name:MATTHEWS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12 GENTLE BREEZE
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04062-7004
Mailing Address - Country:US
Mailing Address - Phone:207-491-9301
Mailing Address - Fax:
Practice Address - Street 1:7 OAK HILL TER STE 211
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-8996
Practice Address - Country:US
Practice Address - Phone:207-491-9301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-29
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL5100101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health