Individual
KELLI CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RBT
Contact information
Practice address
1250 S AW GRIMES BLVD, ROUND ROCK, TX 78664-7429
(512) 401-3612
(512) 717-5553
Mailing address
1250 S AW GRIMES BLVD, ROUND ROCK, TX 78664-7429
(512) 401-3612
(512) 717-5553
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
4649
TX
106S00000X
Behavior Technician
RBT-19-82868
TX
Other
Enumeration date
09/27/2019
Last updated
12/17/2021
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