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Individual
ROBERT JON CLARK JR.
Active
Individual
ROBERT JON CLARK JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA, LPC
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
66476
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
309292601
—
TX
05
—
309292602
—
TX
01
—
8380LC
BLUE CROSS BLUE SHIELD
TX
Enumeration date
06/20/2012
Last updated
06/25/2016
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