Doctor Name: | PAUL JEFFREY CLARK |
NPI Number: | 1457376238 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PHD |
License Number: | 1414 |
Business Practice Address: | 1010 South 7650 East Crow Northern Cheyenne Indian Hospital Crow Agency, MT - 59022 |
Business Phone Number: | 4066383500 |
Business Fax Number: | 4066383569 |
Mailing Address: | Po Box 9, Crow N Cheyenne Hospital Behavioral Health CROW AGENCY |
State: | MT |
Postal Code: | 590220009 |
Phone Number: | 4066383491 |
Fax Number: | 4066383431 |
NPI Enumeration Date: | 07/13/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 1414 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |