Clark, Carly A

Clark, Carly A is an individual health care provider with primary practice located at 620 Ne 2Nd St , Gresham OR 97030-7514. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Behavior Technician, Other Service Providers / Peer Specialist. Other Service Providers / Peer Specialist is her primary health care specialty. Clark, Carly A can be contacted via phone (971) 274-3757.

Contact Information

Primary practice address
620 Ne 2Nd St Gresham OR 97030-7514
Phone: (971) 274-3757
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Behavior Technician 106S00000X Washington
Other Service Providers / Peer Specialist 175T00000X THW000107924 Oregon

Profile Details

NPI number 1689375529
LBN Legal business name Clark, Carly A
Credentials PSS
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 16th, 2023
Last updated Mar 16th, 2023 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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