| Doctor Name: | DR. RONALD EARL CLARK |
| NPI Number: | 1003936824 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | UNLICENSED |
| Business Practice Address: | 3846 E Dartmouth St Mesa, AZ - 852056104 |
| Business Phone Number: | 4802291722 |
| Business Fax Number: | |
| Mailing Address: | 3846 E Dartmouth St, MESA |
| State: | AZ |
| Postal Code: | 852056104 |
| Phone Number: | 4802291722 |
| Fax Number: | |
| NPI Enumeration Date: | 03/29/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | UNLICENSED |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AZ |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |