Clark, Mark W

Clark, Mark W is an individual health care provider with primary practice located at 7507 Ne 51St St , Vancouver WA 98662-6007. He recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Clinical, Behavioral Health & Social Service Providers / Forensic. Behavioral Health & Social Service Providers / Clinical is his primary health care specialty. Clark, Mark W can be contacted via phone (360) 906-1190.

Contact Information

Primary practice address
7507 Ne 51St St Vancouver WA 98662-6007
Phone: (360) 906-1190
Fax: (360) 906-1193
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 103TC0700X PY2226 Washington
Behavioral Health & Social Service Providers / Forensic 103TF0200X PY2226 Washington

Profile Details

NPI number 1114081577
LBN Legal business name Clark, Mark W
Credentials PSY.D.
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 20th, 2006
Last updated Jul 9th, 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 1114081577 NPPES
Oregon MEDICAID 164936

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