Doctor Name: | DR. JEFFREY P. CLARK |
NPI Number: | 1063403822 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PSY.D. |
License Number: | 409 |
Business Practice Address: | 339 W Loucks St Sheridan, WY - 828014121 |
Business Phone Number: | 3076744462 |
Business Fax Number: | 3076744552 |
Mailing Address: | 1969 S Sheridan Ave, SHERIDAN |
State: | WY |
Postal Code: | 828016108 |
Phone Number: | 3076727481 |
Fax Number: | 3076745117 |
NPI Enumeration Date: | 11/02/2005 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 409 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WY |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |