Individual
DR. JAMES ROBERT CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSY.D.
Contact information
Practice address
125 EXECUTIVE DR, SUITE 106, MARION, OH 43302
(740) 382-5133
(740) 383-2289
Mailing address
125 EXECUTIVE DR, SUITE 106, MARION, OH 43302
(740) 382-5133
(740) 383-2289
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
4571
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000333769
ANTHEM
ND
01
—
4535225
AETNA
OH
Enumeration date
03/19/2007
Last updated
04/06/2009
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