Clark, Katherine Travis

Clark, Katherine Travis is an sole proprietor health care provider with primary practice located at 1016 Industrial Park Dr , Clinton MS 39056-3210. She recently has only one registered license in Behavioral Health & Social Service Providers / Psychologist, which is considered as her primary health care specialty. Clark, Katherine Travis can be contacted via phone (601) 383-2998.

Contact Information

Primary practice address
1016 Industrial Park Dr Clinton MS 39056-3210
Phone: (601) 383-2998
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Psychologist 103T00000X 33-522 Mississippi

Profile Details

NPI number 1548458680
LBN Legal business name Clark, Katherine Travis
Credentials PH.D.
Entity Individual
Sole proprietor 1 Yes
Enumeration date Oct 12th, 2007
Last updated Oct 12th, 2007 - about 18 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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Identifiers

StateTypeNumberIssuer
All States NPI 1548458680 NPPES
Mississippi MEDICAID 04587367

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