Doctor Name: | MR. WILLIAM RANDOLPH CLARK |
NPI Number: | 1588854236 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LPC |
License Number: | 61784 |
Business Practice Address: | 12880 Hillcrest Rd J-235 Dallas, TX - 752301532 |
Business Phone Number: | 2147299396 |
Business Fax Number: | 9723850711 |
Mailing Address: | 12880 Hillcrest Rd, J-235 DALLAS |
State: | TX |
Postal Code: | 752301532 |
Phone Number: | 2147299396 |
Fax Number: | 9723850711 |
NPI Enumeration Date: | 07/30/2007 |
NPI Last Update Date: | 06/20/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101Y00000X |
License Number: | 61784 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |