| Doctor Name: | MR. JAMES RICHARD CLARK |
| NPI Number: | 1063740280 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LPC |
| License Number: | C1913 |
| Business Practice Address: | 534 Ne Brookstone Dr Prineville, OR - 977543221 |
| Business Phone Number: | 5416783342 |
| Business Fax Number: | |
| Mailing Address: | Po Box 1211, PRINEVILLE |
| State: | OR |
| Postal Code: | 977540675 |
| Phone Number: | 5416783342 |
| Fax Number: | |
| NPI Enumeration Date: | 11/28/2009 |
| NPI Last Update Date: | 11/28/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | C1913 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OR |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |