Individual
RANDY GENE CLARK SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1639 BRUCE SMITH PKWY, WEST PLAINS, MO 65775-7691
(417) 308-0671
Mailing address
45335 SIERRA HWY, LANCASTER, CA 93534-1611
(661) 949-8599
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
101YP2500X
Professional Counselor
202404464
MO
Other
Enumeration date
08/23/2017
Last updated
04/11/2025
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